Patient Information
Breast Sentinel Node Biopsy
What is Sentinel Lymph Node Biopsy?
Sentinel node biopsy is an operation to remove the first lymph glands under the arm that are responsible for draining the area of the breast involved by a tumour. This gland is then analysed by a pathologist to determine whether there are tumour cells in it. Several large studies have shown the benefit of sentinel node biopsy and it is likely to become the standard treatment for certain breast cancers in the future.
Sentinel node biopsy is a relatively new procedure, however, many thousands of cases have been done throughout the world since it was introduced less than ten years ago. Sentinel node biopsy is still being carefully studied by scientists and doctors. University College Hospital is one of the leading centres in the UK for the development of sentinel node biopsy.
What are Lymph Glands/Nodes?
The lymphatic system is a system of lymph vessels and lymph glands throughout the body which play an important role in your body's mechanism of fighting infections and tumours. The lymph glands responsible for the breast lie mainly within the armpit, but occasionally may be within the chest or neck.
Why is it so important to know whether tumour cells are present in the glands under the arm?
The presence of tumour cells in the glands under the arm is a very strong indicator that this particular breast cancer puts you at risk of spread of the disease elsewhere (metastases). Hence very important decisions regarding the overall treatment of your breast cancer are made, based on whether the lymph glands contain tumour cells. This treatment may involve further surgery, radiotherapy, hormone treatment, chemotherapy or a combination of these treatments.
How do you identify the sentinel lymph nodes?
We use a combination of 3 methods to identify the sentinel lymph
nodes :
1. Sentinel Node Imaging
: This is usually done the day before or on the morning of your operation within the nuclear medicine department. A small amount of radioactive material is injected into the breast. This material is carried into the armpit by the lymph vessels and trapped in the sentinel node, which can be seen on a nuclear medicine scan. This scan only shows where the sentinel node is located, but not whether it contains tumour or not.
2. Blue Dye
Injection :
This is injected once you are asleep in theatre. This dye stains the sentinel node blue, thereby assisting the surgeon to find the correct lymph node. The blue dye may be visible around your scar following surgery – but usually fades over the following weeks or months. Some of the blue dye passes into your bloodstream and is passed out in your urine.
3. Gamma probe detection : A hand-held probe guides your surgeon to the radioactive material injected previously.
What is the advantage of Sentinel Node Biopsy?
Sentinel node biopsy is an accurate way of determining the stage of your disease. It is a significantly smaller operation than axillary lymph node dissection – resulting usually in a smaller scar, less pain, more rapid recovery and fewer long term side effects.
What are the disadvantages of Sentinel Node Biopsy?
In less than 5% of cases sentinel node biopsy does not accurately predict disease within the armpit, hence a small number of people who have a negative sentinel node biopsy may later be found to have disease under the arm.
The blue dye may stain the skin around your scar following the operation. This is uncommon, and usually gradually disappears.
There have been rare instances (1%) of allergy to the dyes used in sentinel node biopsy.
What will happen if my Sentinel Node contains tumour?
We would normally recommend a second operation to remove all of the lymph nodes within the armpit (axillary lymph node dissection) or radiotherapy to the armpit.
How long will it take to get the results from my sentinel node biopsy?
When the sentinel nodes are removed, they are analysed by a pathologist under the microscope. Usually a result will be obtained within a week of the operation. Occasionally special tests are required on the sentinel node, which may take longer. A rapid test (called “imprint cytology” or “frozen section”) may be done on the sentinel node while you are asleep. This rapid test will detect cancer, if it is within the lymph glands in approximately 80% of patients. This rapid test enables an immediate decision to proceed (if necessary) to remove all of the lymph glands under the same anaesthetic, thereby avoiding a second operation. We will tell you the results of the sentinel node biopsy as soon as possible – and may recommend further treatment based on these results.
Does Sentinel Node Biopsy affect whether I have a Lumpectomy or a Mastectomy?
No - Having sentinel node biopsy will not affect whether your tumour is suitable for lumpectomy (wide local excision) or mastectomy.
Is the radioactive dye harmful?
The dose of radiation you are exposed to for sentinel node biopsy is very low - similar to that of undergoing mammograms and much less than having a CT scan.
Can Sentinel Node Biopsy be unsuccessful?
In less than 5% (One in twenty) patients, the sentinel node can not be identified. If this happens we would normally recommend the treatment offered before the advent of sentinel node biopsy, which is axillary lymph node dissection.
What if I decide that I do not want to undergo Sentinel Node Biopsy?
The decision to undergo sentinel node biopsy is entirely up to you. If after finding out about sentinel node biopsy, you decide you do not want to undergo it – it is always best to let the team that are looking after you know as soon as possible. This is so that the alternatives can be explained and alternative arrangements can be made.
What if I have further questions about Sentinel Node Biopsy?
You can feel free to ask your consultant, the breast care nurse or any one of the doctors or nurses involved in your care about sentinel node biopsy.
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