Sentinel Node Biopsy

Finding out that you have breast cancer can be frightening. Often times women (and men) fear loosing a breast or even their life to cancer. If a patient requires surgery for breast cancer - either a mastectomy or a lumpectomy, the surgeon will typically remove some or all (10 to 30) of the lymph nodes located in the axilla (armpit). This procedure is performed so that surgeons can detect if cancer has spread to other areas of the body. If the lymph nodes are positive, the conclusion is made that the disease has spread.

The long-term effects of a traditional axillary lymph node dissection may include: nerve damage, limited rang eof motion in the arm and even lymphedema (severe swelling of the arm). While none of these side effects are life threatening, they can be very uncomfortable and even debilitating. While axillary lymph node dissection has been the "gold standard" of detecting the spread of cancer - surgeons and cancer patients now have a new alternative - sentinel node biopsy.

Lymphedema of the arm occurs in 10% to 15% of patients after a traditional axillary lymph node dissection. Since 76% of patients find that the cancer hasn't spread to other areas of the body, future risks of discomfort, infection and injury can be avoided.

Sentinel node biopsy has become a popular method of "mapping" breast cancer because it is less invasive and carries a lower risk of complications that the traditional detector - axillary lymph node dissection.

With the use of the low-level radioactive tracer technetium-99, blue dye and a hand held gamma ray counter (Geiger counter), the surgeon can detect if cancer has spread to other areas by removing anywhere from one to three lymph nodes instead of the traditional 10 to 30. By identifying the first lymph node(s) that an area of the breast drains to (the sentinel lymph nodes), the procedure is attempting to likewise identify the probable node(s) that cancer would spread to and therefore the appropriate node(s) to biopsy to determine the spread of the cancer.
 

So, how does sentinel node biopsy work?

The radioactive tracer and blue dye are injected into the breast near the area of the breast tumor. The surgeon uses a Geiger counter to locate the tracer and makes an incision - approximately one-half inch to remove the sentinel node(s). The blue dye serves as a visual indicator of the node(s) exact location during surgery. After the node(s) have been removed they are examined by a pathologist to determine if they contain cancer. If none is detected, the conclusion is made that the cancer has not spread beyond the breast. If the node(s) are positive, standard lymph node dissection is required to determine the extent of the invasion.Grace Hospital has adopted the NC-American College of Surgeons protocol to assess the accuracy of the procedure where 20 concomitant dissections are done. On June 3, 2003, Dr. William G. Cloud completed the first sentinel node biopsy to be performed at Grace Hospital.

The benefits of sentinel node biopsy over axillary node dissection include: less invasive, decreased chance of lymphedema (because fewer nodes have been removed), shorter recovery time and smaller incisions required. Sentinel node biopsy is not recommended for patients who have lymph nodes that are easily felt, advanced breast cancer, multiple areas of breast cancer, previous breast surgery - including breast reduction or previous radiation therapy to the breast.

Dr. Cloud is a board-certified surgeon who has significant experience in cancer and abdominal surgery, and particularly laparoscopic surgery. Dr. Cloud is a referral source for many physicians confident in his skills and commitment to patient care. For additional information, please call Dr. Cloud at 828.437.0847.

The tracer and blue dye
migrates to the nodes
under the arm