![]() ![]() then applied sentinel lymph node mapping with injected radiotracer using the gamma probe in the treatment of breast cancer in 1993. 6 By the 1970s, it was noticed that some nodes received drainage before others and were termed, the “sentinel node.” 7 Lymphatic mapping with the purpose of discovering the sentinel node was first described in 1992 for cutaneous melanoma with the use of blue dye by the late Donald Morton. Historically, the concept of a mapping lymphatic drainage began in the 1950s. 4, 5 The sentinel node biopsy (SLNB) has transformed the surgical management of early breast cancer and although it is now the standard of care we continue to explore the utility of the procedure in more controversial areas such as post neoadjuvant therapy, explore information about the host response to cancer, and test new refined reagents to better identify lymph nodes with metastatic cancer as well. 3 Its relatively low false negative rate of 5 to 10% and high sensitivity rate of 90 to 95% in the detection of cancer to the lymph node basin has made this minimally invasive operation a standard. 1, 2 By definition, the sentinel lymph node is frequently the first node in the lymphatic basin that receives drainage from an anatomic region and is immunologically responsible for that region. This helps to check that the sentinel nodes have been located and the surgeon can then remove them for testing.įor more on this, see our general section on Surgery.The status of the axillary lymph nodes is one of the strongest prognostic factors in women with early stage breast cancer, and the sentinel lymph node biopsy (SLNB) has become the standard of care in the assessment of metastatic spread to the lymph node basin. Handheld probeAs well as looking at where the blue dye travels to first (if used), the surgeon uses a small handheld device called a probe during the biopsy to detect the radioactive substance injected during the lymphatic mapping. Your skin may look a bit grey, but will fade once the dye washes out in your urine. You may also have a blue patch on the breast for weeks or longer. This is done under general anaesthetic during the biopsy.īecause of the dye, you may notice blue-green urine (wee) and bowel movements (poo) when you go to the toilet the next day. The dye moves into the lymphatic vessels and stains the sentinel nodes first. Lymphatic mapping is done either on the day of the biopsy, or the day before the biopsy.īlue dye injection (not always used)If dye is being used, it will be injected into the breast. These are most likely to be the sentinel nodes. Lymphatic mappingA small amount of a harmless radioactive material is injected into the skin over the breast cancer tumour.Ī CT scan is then taken to show which lymph nodes the radioactive material flows to first. To work out which lymph nodes are sentinel nodes, one or a combination of these procedures is used: Side effects are usually worse after axillary lymph node dissection because more lymph nodes are removed. You may have arm or shoulder stiffness, weakness, reduced movement and pain numbness in the arm, shoulder, armpit and parts of the chest seroma – which is fluid collecting near the surgical scar lymphoedema and cording. The results also guide what other treatment your doctor recommends. If cancer is found in the lymph nodes, then most or all of the axillary lymph nodes (usually 10–25) will be removed to reduce the risk of the cancer coming back (recurrence) in the armpit. This is also called axillary lymph node clearance (AC). If there is more than a small amount of disease in the sentinel nodes, you may have axillary lymph node dissection or radiation therapy. If there are no cancer cells in the sentinel nodes, the rest of the lymph nodes are left in place. A sentinel node biopsy finds and removes them so they can be tested for cancer cells. When breast cancer spreads outside the breast, it first goes to particular lymph nodes in the armpit or near the breastbone (sternum). There are two main types of axillary surgery. It is usually done during breast surgery but may be done in a separate operation. The operation to remove lymph nodes is called axillary surgery. Removing some or all of these lymph nodes helps your doctor to check for any cancer spread. ![]() The axillary lymph nodes, which are in and around the armpit, are where cancer cells from the breast usually spread to first.
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