• Mastectomy 

  • Sentinel Node Biopsy

Sentinel node biopsy involves removing the first lymph node (or nodes) in the armpit to which cancer cells are likely to spread from the breast.

What is the sentinel node?

The sentinel node is the first lymph node to which breast cancer cells may spread outside the breast. Although some women may have one sentinel node, some may have two or three sentinel nodes. Usually the sentinel node is in the armpit (axilla). Sometimes the sentinel node is in another part of the body — for example, in the chest between the ribs under the breast or above or under the collarbone. View a picture of lymph nodes near the breast.

 

What does the procedure involve?

The radioactive fluid (usually about 1–2 ml) is injected into the breast around cancer or under the areola before surgery. A special scan is done to find out to which lymph node(s) the radioactive fluid has traveled. During surgery, the blue dye is also injected into the breast. The blue dye will travel to the lymph nodes via the lymphatic vessels and the sentinel lymph node(s) should turn blue.

The surgeon can see the blue sentinel node(s) and detect the radioactive substance using a type of Geiger counter called a gamma probe. The surgeon can then remove the sentinel node(s). If more than one sentinel node is found, all the sentinel nodes are removed. If another enlarged lymph node is found in the armpit without dye in it, the surgeon will usually remove this node as well. If the sentinel node is not in the armpit, the surgeon will remove it if this can be done safely.

 

Is sentinel node biopsy always accurate?

In a small number of women, the sentinel node doesn’t have cancer cells, even though there are cancer cells in other lymph nodes in the armpit. This is called a ‘false-negative result’.

A false-negative result sometimes occurs because lymphatic vessels running to the lymph nodes that have cancer cells in them are blocked by cancer cells. This means that the dye goes into other normal lymph nodes instead.

To minimize the chance of a false-negative result, the surgeon may remove any enlarged nodes that are found at the time of surgery, even if they do not contain the dye.

 

Side effects of sentinel node biopsy

Clinical trials have shown that sentinel node biopsy is associated with a lower risk of arm problems than axillary dissection. This means that the risk of numbness, shoulder stiffness and lymphoedema is lower than with axillary dissection.

There’s a small risk of allergic reaction to the radioactive fluid or blue dye used to find the sentinel node. Allergic reactions are usually mild and easily treatable.

Rarely, women may experience a severe allergic reaction (less than 1 in 5000 cases). A doctor may decide not to use the blue dye for sentinel node biopsy if there’s reason to think a woman may be at significant risk of allergy to the blue dye.

If blue dye is used to find the sentinel node, the urine may turn blue for 24 hours after surgery. The skin of the breast may also become blue but this will fade with time.

There will be some pain associated with sentinel node biopsy, and injection of the radioactive isotope sometimes stings.

 

  • Axillary Clearance Surgery

Axillary dissection involves removing several or all of the lymph nodes from the armpit.

If possible, this will be done during breast surgery (Lumpectomy surgery or mastectomy) and may be done through the same incision as the breast surgery itself. However, it may be done as a separate operation.'

 

 

Because the number of lymph nodes in the armpit varies from person to person, the number of lymph nodes removed and the length of the operation will be different for each woman.

 

 

After axillary dissection, the lymph nodes are examined by a pathologist. The number of lymph nodes that have cancer cells in them will help the doctors decide what other treatments are best.

Treatment may involve systemic therapies (therapies that treat the whole body), such as chemotherapy or hormonal therapy, and less commonly, radiotherapy to the armpit.

 

Side effects

 

Clinical trials have shown that sentinel node biopsy is associated with a lower risk of arm problems than axillary dissection. This means that the risk of numbness, shoulder stiffness and lymphoedema is lower than with axillary dissection.

There’s a small risk of allergic reaction to the radioactive fluid or blue dye used to find the sentinel node. Allergic reactions are usually mild and easily treatable.

 

Rarely, women may experience a severe allergic reaction (less than 1 in 5000 cases). A doctor may decide not to use the blue dye for sentinel node biopsy if there’s a reason to think a woman may be at significant risk of allergy to the blue dye.

If blue dye is used to find the sentinel node, the urine may turn blue for 24 hours after surgery. The skin of the breast may also become blue but this will fade with time.

There will be some pain associated with sentinel node biopsy, and injection of the radioactive isotope sometimes stings.

 

 

 

**Sources:

Breast Cancer Network  (Surgery), National Breast Cancer Foundation (About breast cancer), Medline Plus (Mastectomy), Cancer Australia (Mastectomy), Cancer Australia (Breast reconstruction), Mayo Clinic (Mastectomy: How you prepare), AustraliaSourcesMyVMC (Mastectomy), Mater Private Breast Cancer Centre (Mastectomy and Breast Cancer Information), Cancer Australia(Psychosocial impact in the areas of body image and sexuality for women with breast cancer),Cancer Council (Changes to appearance)

 

 Cancer Australia 

© 2019 by Thair Mb chB General Surgeon