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Sentinel Lymph Node Biopsy
Sentinel Lymph Node Biopsy
Everything You Need To Know Nipple Sparing Mastectomy
What is sentinel lymph node biopsy?
Sentinel lymph node biopsy, or SLNB, is now the standard method used to examine the lymph nodes of women with early-stage breast cancer. The sentinel node is the first area in the body where cancer cells can spread beyond the primary breast tissue. There are usually 1-3 sentinel nodes in the body. The purpose of performing a sentinel lymph node biopsy is to avoid the need to remove more lymph nodes than necessary in an axillary lymph node dissection for patients with mostly cancer-free sentinel nodes.
Who is a suitable candidate for sentinel lymph node biopsy?
SLNB is used for the staging of patients with early-stage breast cancer (T1-2) and clinically non-invasive axillary nodes regardless of surgical treatment. Patients with ductal carcinoma in situ (DCIS) undergoing a mastectomy are candidates for an SLNB due to the disruption of the lymph nodes during mastectomy. SLNB may also be performed in patients with DCIS who require large resection or other oncoplastic procedures that may disrupt lymphatics. In addition, SLNB may be an option in patients with ipsilateral recurrence of breast cancer following breast conservative therapy, or recurrence after a mastectomy.
Preparation for sentinel lymph node biopsy
Before performing a sentinel lymph node biopsy, the healthcare provider will:
- Take the patient’s medical and physical history.
- Examine the breasts and underarms for any lumps.
- Discuss the expected results and treatment approach of the procedure.
- Explain the possible risks associated with the procedure.
- Describe the type of sedatives used for the procedure.
Before getting a sentinel lymph node biopsy , patients are required to
- Get all the required blood and imaging tests done.
- Stop smoking and consuming alcohol for 6 weeks before and after surgery.
- Refrain from consuming certain medications and supplements.
- Fast for at least 12 hours before the procedure
Procedure for sentinel lymph node biopsy
A few hours before the procedure, a small dose of a mildly radioactive liquid (tracer) is injected into the breast near the site of the cancer. During the procedure, the surgeon may also add a small dose of blue dye to the breast. The blue dye and tracer will drain away from the breast tissue into the surrounding lymph nodes. A surgeon can see which group of lymph nodes gets the dye first, and a radioactive monitor is used to detect the group of lymph nodes that gets the tracer first. Generally, 1 to 3 sentinel nodes will be removed, and the lymph nodes will be sent to a pathologist for microscopic examination.
Post-procedure care and recovery for sentinel lymph node biopsy
The healthcare team may shift the patient to a recovery room, where they will monitor the patient for any complications associated with the procedure. If no further surgery is required, the patient may be discharged the same day. Pain medications will be prescribed to alleviate pain. It is generally recommended to wait a few weeks before engaging in physical activity, such as running, exercising, or lifting. The incision should be kept clean and allowed to heal naturally.
Risks and complications for sentinel lymph node biopsy
Sentinel lymph node biopsy procedure is generally considered to be a low-risk procedure compared to the traditional axillary dissection procedure. However, there are potential risks associated with the procedure, such as hemorrhage, infection, nerve damage, lymphadenopathy, and the requirement of additional surgery in the event of significant nodal involvement or recurrence of the axillary disease.
FAQs
A sentinel lymph node biopsy (SLNB) usually takes about 30 minutes to complete. However, many patients undergo SLNB during breast surgery. If the SLNB is accompanied by breast surgery, it may take longer.
If the sentinel lymph node biopsy results are positive, it indicates that the cancer has spread to other lymph nodes outside the breast. Axillary lymph node dissection, a procedure to remove other lymph nodes in the underarm has been a common course of treatment following a sentinel lymph node-positive biopsy to reduce the likelihood of cancer recurrence.
The accuracy rate of sentinel lymph node biopsy is approximately 95%, with a false positive rate ranging from 5 -15%. According to a study published in the Journal of the National Cancer Institute, the accuracy rate of sentinel lymph node biopsy was 98% when used in combination with radioactive colloid.
Individuals may experience numbness or tingling near the area of the biopsy site, which can last anywhere from one week to few months.
Avoid sleeping on the side of the biopsy site in the first few hours after the procedure. This is to reduce pressure and discomfort at the biopsy site and to ensure proper healing.