Sentinel Lymph Node Biopsy

Lymph nodes are oval-shaped glands which contain cells that defend the body against foreign substances. They are part of the lymphatic system and are present in different parts of the body including the neck, armpits, behind the ears, chest, abdomen and groin. A sentinel lymph node is considered the first node that drains a primary cancer. Sentinel lymph node biopsy is a procedure to remove the sentinel lymph node closest to the cancerous organ to examine it for malignancy.

Sentinel lymph node biopsy is performed on an inpatient basis and is usually done as aday stay procedure if done on its own but may be done as an inpatient in combination with other cancer surgery. Preoperatively the node will be marked using a radioactive isotope which is injected near the cancer or in the same quadrant. The isotope is taken up by the same node that drains your cancer. During surgery, your doctor injects blue dye close to the cancer. The sentinel lymph node can then be identified by the dual marking technique. The skin around your lymph node is cleaned and a small incision is made. Your surgeon removes the lymph node. A frozen section may be performed on the sentinel node by sending it to the laboratory whilst the patient is asleep to determine if cancer cells are present. This will allow the surgeon to proceed onto an axillary clearance if necessary and avoid further surgery later. The frozen section is about 80% accurate and further surgery may be required if the frozen section was negative at time of surgery. The node will be further assessed in more details as normal to ensure that nothing is missed.If the risk of disease in the lymph nodes is low, a frozen section will not be performed. The incision is then closed with the help of sutures.

A negative result for cancer cells in the armpit indicates that the cancer is limited to the breast and has not spread to other parts of the body. However, the presence of cancer cells in the sentinel lymph node(s) indicates that the cancer may has spread from the primary organ, possibly to other lymph nodes and other organs. Sentinel lymph node biopsy is important in determining the extent of disease and staging of the cancer, especially in breast cancer and a form of skin cancer. The biopsy results help your doctor to develop an appropriate treatment plan.

As with any procedures, sentinel lymph node surgery may be associated with certain risks and complications such as pain, bleeding, swelling, infection of the incision site and nerve injury.

Axillary Clearance

Axillary Clearance refers to the removal of larger number of lymph nodes from the armpit. The lymph nodes are arranged in levels in the armpit with the level 1 closest to the breast and level 3 towards the neck. An axillary clearance includes any and all levels. A typical clearance includes levels 1 and 2 and removes between 10 and 20 lymph nodes. If the axilla contains more malignant nodes, a clearance up to level 3 will be done to try to remove all disease and prevent local recurrence. It also gives prognostic information used to guide treatment of the cancer.

As with any procedures, axillary clearance surgery may be associated with certain risks and complications such as pain, bleeding, swelling, infection, frozen shoulder, lymphoedema of the arm and nerve injury.