Sentinel Lymph Node Dissection

This information is given to provide you with an understanding of the procedures you will experience with the removal of your sentinel lymph node(s). The sentinel lymph node(s), is (are) believed to most likely contain disease if the cancer has spread from the breast to the lymph nodes. Sentinel lymph node biopsy has been developed to decrease the potential complications of removing multiple lymph nodes in your armpit. Scientific evaluation of removing and testing fewer lymph nodes during breast cancer surgery is ongoing. You may be asked to participate in a clinical trial.

Who is a candidate for this?
If your tumor is 3 cm or less, and your health care providers do not feel cancer in your lymph glands, then you can have this procedure. The indications are changing and we have several clinical trials to improve how we use sentinel lymph node biopsy.

Pre-Operative:
On the day of your procedure, report to your pre-registration area. Check for this location in materials given to you by the surgery scheduler. You will be shown to a room where you will change into a hospital gown, and a nurse will start an IV. Then you will be taken to Nuclear Medicine on a guerney. Your family member(s) may accompany you.

Lymphoscintigraphy:
There are several ways to locate the sentinel node: a nuclear medicine scan called lymphoscintigraphy, blue dye or both. Your physician will choose which combination is best for you. In the Nuclear Medicine Department, a nuclear medicine physician injects a small amount of radioactive material (technetium sulfur colloid) into the skin around the site of the breast cancer. The material moves through the skin's lymphatic channels, and a special scan called lymphoscintigraphy determines the location of the regional lymph node(s) in your armpit most at risk for containing cancer cells.

During the procedure, which takes about one hour, you will be lying on your back on a table; a large camera will be moved around your body, and a technician will make images. The amount of radiation exposure with this procedure will be less than that of a routine chest x-ray.

The sentinel lymph node(s) is then identified and its location marked on the skin with a marker. The side effects associated with this procedure are slight pain at the injection site during and shortly after injection, possible redness and tenderness at the injection site lasting 1-2 days, and rarely, infection.

You will then be escorted to the holding area outside the Operating Room, where you will meet the anesthesiologist who will discuss the medications you will receive during the operation.

Intra-operative "Blue Dye" Mapping and Lymph Node Dissection:
In the Operating Room, lymphatic mapping is performed; the surgeon injects a blue dye (isosulfan blue) into the skin around where the breast cancer is or was. The blue dye is picked up by the lymphatic vessels and travels to the sentinel node(s). The blue dye may discolor (a blue tinge) the injected skin, the lymphatic channels, and the urine. If the discolored skin is not completely removed surgically, the blue color will remain for several weeks (sometimes months). The urine will return to normal color in 2-3 days. There is a possibility of allergic reaction to the blue dye at the time of injection, although this is rare.

While you are in the Operating Room, readings will be done with a device called a Neoprobe (gamma counter), by placing a metal probe on specific areas of your skin, over the area of your breast cancer, as well as the lymph node(s) in your armpits. The machine then records numbers measuring the radioactive material (the technetium sulfur colloid injected in Nuclear Medicine), and assists the surgeon in locating the lymph node(s) to be sampled during the operation.

Following the lymphatic mapping, an incision is made in the armpit. A lymph node(s) that is blue, or has a high count, is a sentinel lymph node. It will be removed and sent to the pathology department where special stains will be done to more closely examine these lymph nodes. Whether or not further lymph nodes are removed depends on your individual situation. Please discuss what is appropriate for you with your surgeon or nurse. All of the information about your lymph nodes will be reported in your pathology report that you will review with your surgeon.

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