Sentinel lymph node biopsy

Breast cancer starts in the breast but if it is left untreated, it can spread to the rest of the body. We aim to detect and treat breast cancer before it has spread elsewhere. Usually, if breast cancer is going to spread, it goes to the lymph nodes in the armpit before moving to the rest of the body.
 
If you are diagnosed with breast cancer at Breast Care Leicester , we would normally carry out an ultrasound scan of the lymph nodes in your armpit to detect any large cancer deposits. Provided this shows no involvement, we would advise a sentinel lymph node biopsy at the same time as your breast surgery . This is a procedure in which we remove between 1 and 4 lymph nodes and send them for analysis by the pathologist.
 
If there is no microscopic disease, no further surgery is required to the armpit. If there are significant lymph node involvement, we might advise further treatment to the armpit, which would be either surgical axillary lymph node clearance or axillary radiotherapy.
 
Sentinel lymph node biopsy aims to identify the lymph nodes in the axilla to which the cancer is most likely to have spread. Before your surgery, you will have an injection of radioisotope into the breast. This tracks to and collects in the sentinel lymph node(s). Once you are anaesthetised in theatre, we will also inject blue dye which also tracks to and collects in the sentinel lymph node(s). The amount of radioactivity injected is very low, aiming to be just detectable when the gamma probe, which is a very sensitive instrument, is held within a few centimetres of the node.
 
As part of your operation we will dissect down to these lymph nodes, guided by a gamma probe (pictured) which detects the radioactivity in the node(s). Once located, the node should also appear blue because of the dye. In most cases we use both radioactivity and blue dye in case one or other doesn't work successfully. In the instances where neither works, we would usually take four nodes from the anatomical area where the sentinel node(s) are most commonly located. The "four node sample" is a well validated technique and was a standard operation before sentinel lymph node biopsy was widely introduced and validated.
 
Any axillary operation can have short- and long-term complications which include lymphoedema (fluid retention and arm swelling); shoulder stiffness; bleeding; haematoma; seroma; pain; numbness/altered sensation; nerve or blood vessel injury and scarring. Limiting the extent of surgery in the axilla when possible (by carrying out sentinel lymph node biopsy or axillary sampling rather than axillary node clearance ) is believed to reduce the likelihood of lymphoedema and shoulder stiffness, but they can still occur. We would advise regular exercises after your operation to maintain your range of shoulder movement.
Breast care Leicester: sentinel lymph node biopsy
Breast Care Leicester Gamma probe sentinel lymph node biopsy
Therapeutic mammoplasty
Wide local excision
Mastectomy
Axillary node clearance
Breast reconstruction