If you have been diagnosed with breast cancer your doctor may want to perform
a sentinel lymph node biopsy there are three reasons to check lymph nodes
for any cancer but for breast cancer the reasons are to stage the patient
appropriately so we can predict
survival and outcome The second reason then is to determine treatment
based on that stage
of a patient and the third reason is to
remove cancer cells and decrease the amount tumor
by actually physically removing the lymph nodes that may harbor tumor cells
Our body contains two separate systems for transporting fluids
The circulatory system and the lymphatic system The more familiar circulatory
system transports blood
The lymphatic system is composed of lymphatic vessels and lymph nodes which
are collections
of grape like structures The lymphatic system
transports lymph, a colorless fluid and lymphocytes
specialized cells of the immune system Like small streams merging to form a
river
small lymph ducts merge into increasingly larger lymph vessels
that ultimately empty into the bloodstream the lymphatic system serves
many purposes including
the filtration of foreign objects like bacteria, fluid transport
and the initiation of the immune response the lymphatic system is also where
cancer cells can drain
collect and gain access to other parts of the body
Lymphatic fluid actually bathes the breast and then drains through lymphatic channels much
as
rivers would drain into a larger body of water
so these channels then drain into one or two or three or four lymph nodes
and with certain die injecting techniques we're able to identify those
important drainage lymph nodes
and the theory behind sentinel lymph node is if we check
those first and they do not harbor any tumor
if there's no tumor in those lymph nodes then we don't have to remove
more lymph nodes in that particular patient
The technique of sentinel lymph node mapping involves injecting a dye
and one can either use two different types of dye
a radioactive dye called technetium sulfur colloid
and/or a blue dye called isosulfan blue
or methylene blue It's very appropriate to use one or two
or both it just depends on that particular surgeons training and
abilities
to find the sentinel lymph node In the blue dye technique
a small amount of blue dye is injected into the breast near the tumor
the dye spreads rapidly through the region after five to 10 minutes
it will have traveled to the lymphatic vessels in the area A blue stained vessel
is found and followed until the lymph nodes are reached
The blue stained nodes closest to the tumor are the sentinel nodes
The sentinel nodes are then removed and examined for the presence of cancer
cells
In the radioactive colloid technique,
a small amount of radioactive material is injected into the breast
4 to 6 hours before surgery After sufficient time had elapsed
A surgeon uses a special handheld detector to identify the areas
emitting high levels of radiation These areas contain lymph nodes that have taken
up larger amounts of the radioactive material These notes with high levels of
radiation
are called hot nodes and sometimes that is done the day before or the day of
surgery
so the patient would have to come in the day before perhaps
and get that injection which would be injected
around the tumor or around the nipple area or a complex
The amount of radioactive dye that we use for this procedure
is very minimal and it's quite safe to be around other people and being around
your children
traveling in your car on the bus and be next to people it's very similar to
the amount
used in a bone scan
In the operating room after we
identified the lymph nodes and removed them some surgeons will send them right
away to pathology to examine
by a frozen section to see if there are tumor cells
in those lymph nodes because if there are tumor cells in the lymph nodes then
again some surgeons that same day
will go ahead and perform a complete axillary lymph node dissection
in order to determine whether they're other lymph nodes involved
in that particular patient The side effects of sentinel lymph node biopsy are usually
limited to tenderness around the area of surgery that should subside with time
other more serious side effects that can occur include numbness,
limited range of motion, infection and Lymphedema
these side effects are less common but they may occur and can have lasting
implications on your daily life For more information on breast cancer please go
to www.cancerquest.org
www.cancerquest.org