Sentinel Lymph Node Biopsy
A sentinel lymph node biopsy is a surgical approach to identify and remove the sentinel lymph node to determine if the cancer has spread, and if so, how far.
Lymph nodes are an important part of the immune system. They contain the cells that monitor foreign substances, like bacteria, viruses and cancer. Sentinel lymph nodes are the first nodes that drain from the breast or original tumor, and mapping them helps to identify the lymph nodes that are at the highest risk for cancer.
What happens during a sentinel lymph node biopsy?
Before surgery, a surgeon or nuclear medicine provider injects a marker called a radiotraced and/or blue dye around the site of the tumor. The radiotracer/dye flows through the lymphatic system – a path or network of lymph channels and nodes. This allows the surgeon to see what lymph nodes are draining from the tumor first and identify the sentinel lymph node(s).
Surgeons usually remove between 1-4 SLN on average, the armpit area (oxilla) has between 20 to 40 LN.
Patients are placed under general anesthesia. After removal of the primary tumor, the surgeon makes a small incision on the skin and in the underarm/oxilla and identifies the lymph node for removal. A pathologist studies the lymph node to determine if it contains cancer.
A sentinel lymph node biospy is often performed as an outpatient procedure. Most patients can leave the hospital on the same day unless they’re having additional surger. You will need to have an adult drive you home. Check with your doctor for specific aftercare instructions, including when you can resume normal activities.
Is a sentinel lymph node biopsy painful?
Some patients have reported brief pain or discomfort when the radiotracer is injected into the tumor site. We can administer a numbing agent to help minimize discomfort. This part of the procedure is relatively quick. We can usually inject the radiotracer around the tumor in less than 45 seconds.
The actual biopsy is done while the patient is under anesthesia. They will be asleep and should not feel any pain.
What happens if a sentinel lymph node biopsy is positive?
In most cases, a negative sentinel lymph node biopsy means the cancer has not spread. The sentinel lymph node biopsy will be negative in 70% to 80% of patients. A positive biopsy means cancer was found in the lymph node. It could be in other lymph nodes and even other organs. If the biopsy is positive, your doctor may remove other lymph nodes that could contain a disease. You may also need additional cancer treatment to include chemotherapy and/or radiation therapy.
What are the benefits of sentinel lymph node biopsy?
The technique uses a smaller incision and may prevent patients from needing more invasive surgery. It can shorten recovery times and lower the risk of side effects like lymphedema, tissue swelling caused by the removal of more lymph nodes.
What are the risks of a sentinel lymph node biopsy?
The risks are very low risk, aside from a 1% to 2% chance that a sentinel lymph node would not be able to be identified.
Some patients have concerns about the radiotracer used to find the sentinel lymph node. While it is radioactive, the tracer has a very low-energy emission particle. No severe adverse reactions have been reported, and the only negative reaction reported has been rare episodes of brief pain during the injection.
Patients who have a sentinel lymph node biopsy may also experience lymphedema, but they’re less likely to than those who have an open surgery.
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