What’s it all about?
Breast cancer treatment can be confusing. One of the procedures you may hear about is the sentinel node biopsy. This helps doctors figure out if the cancer has spread beyond the primary site. Here we’ll explain what a sentinel node biopsy is, how it’s done and what it means for your treatment plan. If cancer is found in the sentinel nodes, more surgery may be needed to remove more lymph nodes.
What is a Sentinel Lymph Node Biopsy?
A sentinel node biopsy involves removing the first lymph node, or nodes, where cancer cells are most likely to spread. These nodes are called sentinel nodes and are the first to which breast cancer cells will metastasise. By looking at these nodes, surgeons can see if the cancer has spread and what to do next.
The Sentinel Node
The sentinel node is the first node to which cancer cells will spread from the breast. This node is a vital part of the lymphatic system, acting as a filter to trap cancer cells and other foreign substances. Usually found in the armpit, the sentinel node can also be found in other areas such as between the ribs in the chest or above or below the collarbone. Understanding the sentinel node is key to diagnosing and treating breast cancer as it gives us valuable information about the spread of the disease.
How Does it Work?
A small incision is made in the armpit during a sentinel node biopsy. A blue dye or radioactive substance is injected to help find the sentinel nodes. The surgeon then uses a gamma probe to locate these nodes. This is often done in conjunction with other procedures like lumpectomy or mastectomy to get a full picture of the patient’s condition.
How is the Sentinel Node Found?
Finding the sentinel node involves a combination of techniques. One common method is lymphoscintigraphy, a nuclear medicine test done before surgery. In this test, a small amount of radioactive material is injected around the cancer or under the nipple. This radioactive tracer goes to the sentinel node and the surgeon can then locate it. On the day of the surgery, a blue dye is injected into the breast, which stains the sentinel node blue, making it easier to see. The surgeon then uses a gamma probe to find the radioactive substance and remove the sentinel node.
Why is it Important for Cancer Cells?
The sentinel node biopsy is key. It shows us if there are cancer cells in the lymphatic system which is crucial for treatment planning. If the sentinel nodes are clear, it’s likely the cancer hasn’t spread to other lymph nodes. That means fewer lymph nodes need to be removed which reduces the risk of complications. Sentinel node biopsy minimises the number of lymph nodes removed so reduces the risks of bigger surgeries like lymphedema and better recovery outcomes.
What to Expect Before
Before a sentinel node biopsy, you may have questions. Your surgeon will explain everything, including what to expect. Dr. Nasrin Davarpanah will arrange your appointment at the radiology department for a radioactive injection into your breast. This injection is typically done on the morning of your surgery. However, if your surgery is scheduled for early in the morning, the injection may be done the afternoon before. After the injection, images will be taken to map the lymphatic pathways in your armpit. This helps the surgeon identify where to locate the sentinel node during surgery.The Procedure
If the ultrasound scan of your armpit was normal, your surgeon will remove the first node that breast cancer spreads to (the sentinel node) to make sure that it doesn’t contain cancer cells. Even though your nodes looked normal on the scan, there is still a 20–30 per cent chance that there might be tiny cancer deposits which are too small to see.
Two techniques are used to find the sentinel node (some surgeons use just one and some use both together). The first technique uses a small amount of a radioactive tracer liquid which is injected into your breast, normally on the day of your operation. The liquid gets trapped in the sentinel node and your surgeon uses a probe to find it. You are not radioactive after the operation, and it is safe for you to be around your family. the day of the biopsy you will be given anaesthesia to keep you comfortable. A small incision will be made and the blue dye or radioactive substance will be injected. The sentinel nodes will be found and removed. The whole procedure takes about 1-2 hours.
If cancer is found in the sentinel nodes, further surgery may be needed to remove more lymph nodes to test how far the cancer has spread.
Alternatives to Sentinel Node Biopsy
While sentinel node biopsy is a common and effective procedure, there are other ways to check the lymph nodes. One is axillary node clearance where all the lymph nodes under the arm are removed. This is more invasive and has higher risks. Another is axillary node sampling where only a sample of lymph nodes from the armpit is removed. But this is less accurate than a sentinel node biopsy. In some cases, sentinel node biopsy may not be recommended and axillary clearance may be needed.
Recovery and Aftercare
After the surgery you may feel some discomfort and swelling in the area. Recovery time for a sentinel node biopsy varies from person to person, some can go home the same day while others may need extended recovery. Follow Dr Nasrin’s instructions for care and recovery. Most patients can go back to normal activities in a few days but it’s best to avoid strenuous exercise for a while.
Risks and Complications
Like any surgery, sentinel node biopsy has risks. It’s generally safe but can have complications like allergic reaction to the dye, false negative results or discomfort around the incision site. Your surgeon will explain these risks to you so you can make an informed decision.
Your Results
After the sentinel lymph node biopsy and the sentinel nodes are examined, your doctor will explain the results to you. If cancer cells are found, further treatment options will be discussed. This may mean more surgery or other treatments specific to your situation.
Conclusion
Sentinel node biopsy is part of breast cancer assessment and management. By knowing what to expect you can feel more comfortable and less anxious. Always ask questions and clarify with your healthcare team. Your health and peace of mind is what matters most.