Sentinel Lymph Node Biopsy

Why is lymph node evaluation necessary?
Most breast cancers today are being diagnosed at an early stage as a result of improved screening methods. Studies have shown that in 80 percent of cancers that have been detected early, axillary dissection (complete removal of the lymph nodes under the arm) finds that the lymph nodes are cancer free. Surgeons can now evaluate the lymph nodes by using a procedure called sentinel lymph node biopsy to evaluate the lymph nodes status. Lymph node status is an important determinant in evaluating whether the cancer has spread in the body. This new procedure can give us the information with less risk and complications than the more extensive removal of lymph nodes. Sentinel lymph node evaluation can be done on patients who are having either lumpectomy or mastectomy.

With sentinel lymph node biopsy, your surgeon needs to remove only a few lymph nodes for examination – the “sentinel” nodes are the first lymph nodes to which cancer cells would travel if they were to spread.

How is a sentinel lymph node biopsy performed?
On the day of your surgery (lumpectomy or mastectomy), you will be sent to the nuclear
medicine department. The radiologist will inject you with a small amount of radioactive substance around the area of your breast tumor. This usually is done several hours before your surgery. The substance dye flows through your lymph ducts to your lymph nodes. Before your surgery, your surgeon will inject a special blue dye around your tumor. Your surgeon will make a small incision in the armpit. Then to identify the sentinel node, your surgeon will track the path of the blue dye and use a device that detects the radioactivity in the lymph nodes. The node or nodes which exhibit these features will be removed while you are still in the operating room and sent to pathology for immediate evaluation.

If the lymph node/nodes are free of cancer, the remaining nodes are not removed and the surgery to remove the nodes is completed. If the sentinel nodes removed have cancer cells present, then your surgeon will do a more complete removal of the lymph nodes for evaluation.

What are the risks of a sentinel lymph node biopsy?
As with any surgery there is a risk of bleeding, infection, and poor wound healing.
Fluid or blood can accumulate and require drainage. A small percentage of patients, less than 1 percent, may have an allergic reaction to the blue dye. There will be some blue staining in the breast skin for a few weeks up to several months. You will also have blue urine for a few days, which is normal.

How will I look and feel after the sentinel lymph node biopsy?
You will have a small scar under your arm which will be covered with steri-strips.
Initially, there will be some swelling and discomfort which can be relieved by using ice packs and Tylenol. This is an outpatient procedure. You will require someone to drive you home since you will receive medication during the procedure that will make you sleepy and unable to drive a car safely.

For more information, please call us at 847-797-9000.