Breast Surgery

Sentinel Node Biopsy

Although axillary lymph node dissection is a safe operation and has low rates of serious side effects, in many cases the breast surgeons at University Surgeons Associates, PC may instead do a sentinel lymph node biopsy, which is a way of learning if cancer has spread to lymph nodes without removing all of them.  This procedure is frequently done with breast conserving surgery and can be done with a mastectomy.

In this procedure the surgeon finds and removes the sentinel node(s), the first lymph node(s) to which cancer cells are most likely to spread from a primary tumor . To identify the sentinel lymph node(s), the surgeon injects a radioactive substance, blue dye, or both near the tumor. . Lymphatics carry the radioactive material into the sentinel node(s) over a few hours. The surgeon then makes an incision in the skin over the area.  The surgeon then uses a handheld gamma camera to find the sentinel lymph node(s) containing the radioactive substance or looks for the lymph node(s) stained with blue dye and removes the nodes. These nodes (often 2 or 3) are then checked with special stains for the presence of cancer cells by the pathologist.

If there is no cancer in the sentinel node(s), it's very unlikely that the cancer has spread to other lymph nodes, so no further lymph node surgery is needed. The patient can avoid the potential side effects of a full axillary lymph node dissection.

If the sentinel node(s) has cancer, a full axillary lymph node dissection is indicated to see find out how many other lymph nodes contain cancer. This is usually done several days after the original sentinel node biopsy. If it is obvious that the sentinel node(s) contains cancer, the surgeon can do an axillary lymph node dissection right away. The cancer may only be found later by thorough microscopic study by a pathologist after the sentinel lymph node biopsy is complete.

Sometimes a sentinel lymph node biopsy is not the best choice.  It is not appropriate if:

  • FNA biopsy of lymph node(s) is already positive
  • Lymph nodes are enlarged or suspicious
  • The primary cancer is > 5 cm in size
  • Multiple primary tumors.
  • The patient has had chemotherapy or antihormone therapy

Sentinel lymph node biopsy is a procedure which requires a great deal of skill and surgical judgement. The breast surgeons at University Surgeons Associates, PC have extensive experience with this technique and perform them regularly.

WHAT TO DO BEFORE SURGERY

  • Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
  • After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
  • Blood transfusion and/or blood products may rarely be needed depending on your condition.
  • It is recommended that you shower with an antibacterial soap the night before or morning of the operation.
  • After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon and/or anesthesiologist has told you to take with a sip of water the morning of surgery.
  • Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and large doses of Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
  • Diet medication or St. John’s Wort should not be used for the two weeks prior to surgery.
  • Quit smoking and arrange for any help you may need at home.

HOW IS SENTINEL LYMPH NODE BIOPSY PERFORMED?

You will most likely be asked to check into the hospital the morning of your surgery.

  • Sentinel Lymph Node Biopsy is usually performed under a general anesthesia.  It usually takes about an hour.
  • If a lumpectomy  is to be done, the Sentinel Lymph Node Biopsy is usually accomplished first.
  • Blue dye is injected beneath the nipple areolar area.
  • An incision is made in the axilla (armpit) just below the hair line.
  • A handheld gamma camera is used to guide the surgeon to the node or nodes seen on the nuclear medicine lymph node mapping.
  • Any blue nodes or nodes found with the gamma camera are removed.
  • After the surgeon removes the intended part of the breast, the incision is closed.

WHAT SHOULD I EXPECT AFTER SURGERY?

Our goal is for your surgery and recovery to be as comfortable and convenient as possible.  After breast conserving surgery, you may experience temporary pain and swelling at the excision site.

  • Most Patients are able to engage in light activity while at home after surgery. Patients can remove any dressings and shower the day after the operation.
  • Post-operative pain is generally mild and patients may require a pain pill or pain medication.
  • Most patients can resume normal activities within a day or two, including driving, walking up stairs, light lifting, and work.
  • You should call and schedule a follow-up appointment within 2 weeks after your operation.

WHAT COMPLICATIONS CAN OCCUR?

Breast biopsy is generally considered extremely safe. As with any operation, there is a risk of a complication. Complications during the operation may include:

  • Bleeding or hematoma
  • Rarely infection of the wound
  • Skin wound separation
  • Adverse reaction to general anesthesia

WHEN TO CALL YOUR DOCTOR

Be sure to call your physician or surgeon if you develop any of the following symptoms after surgery:

  • Persistent fever over 101 degrees F (39 C)
  • Chills
  • Bleeding
  • Pain that is not relieved by your medications
  • Persistent nausea or vomiting
  • You are unable to eat or drink liquids
  • Persistent cough or shortness of breath
  • Purulent drainage (pus) from the incision
  • Redness surrounding the incision that is worsening or getting bigger

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