• Sentinel Lymph Node Biopsy

    Definition

    A sentinel lymph node biopsy is the removal and testing of specific lymph node tissue.
    A sentinel lymph node biopsy is often done during cancer-removal surgery or prior to surgery. The sentinal nodes are the lymph nodes to which cancer would spread first. Sentinel node biopsy is part of the staging process. Staging is an attempt to determine how much the cancer has spread away from the original tumor.
    Lymph Node Biopsy
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    Reasons for Procedure

    This biopsy is done to determine if cancer cells have spread from the tumor to nearby lymph nodes. Cancer often spreads from the tumor to the nearest lymph node or nodes. These lymph nodes are called the sentinal nodes. It is important to understand that the sentinel node will probably be the first one to get cancer if the cancer has spread. In the case of breast cancer, the sentinal nodes are often found in the armpit.

    Possible Complications

    Complications are rare. But no procedure is completely free of risk. If you are planning to have this biopsy, your doctor will review a list of possible complications. These may include:
    • Infection
    • Bleeding or bruising
    • Scarring
    • Nerve damage and chronic pain
    • Allergy to dye
    If the lymph nodes are removed, there is an increased risk of the following:
    • Delayed wound healing
    • Additional pain
    • Lymphedema (a condition in which fluids collect under the skin causing swelling)
    Some factors that may increase the risk of complications include:
    • Obesity
    • Recent or long-term illness
    • Smoking
    • Poor nutrition
    • Use of certain medicines
    • Bleeding disorders

    What to Expect

    Prior to Procedure

    Your doctor will do a physical exam. The cancerous tissue will be biopsied. Tests may include the following:
    Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Aspirin or other anti-inflammatory drugs
    • Blood thinners, such as clopidogrel or warfarin
    Prior to the procedure, you should also:
    • Eat a light meal the night before. Do not eat or drink anything after midnight.
    • Arrange for a ride to and from the hospital.

    Anesthesia

    Depending on the location of the lymph node, you may be given one of the following:
    • General anesthesia —You will be asleep.
    • Local anesthesia—The area will be numb.
    • Regional anesthesia—Your lower body will be numb.

    Description of the Procedure

    A blue dye, and often a radioactive tracer, will be injected into the area where the tumor is. It may be done several hours before surgery. The dye and tracer will travel from the tumor area to the sentinal nodes. This will help identify which nodes are the sentinel lymph nodes. A small incision will be made. The sentinel node (or nodes) will be removed. The removed node will be checked for cancer cells. If cancer is found, the rest of the lymph nodes in that area will be removed.
    If cancer is not seen in the sentinel node, it is unlikely that the cancer has spread to the other remaining lymph nodes. The other lymph nodes are not removed.

    How Long Will It Take?

    The biopsy takes about 30-60 minutes. Surgery to remove the entire cancer takes longer.

    Will It Hurt?

    Anesthesia prevents pain during surgery. Pain medicines are given during recovery.

    Post-procedure Care

    The result of the sentinel lymph node biopsy determines if additional lymph nodes need to be removed. It can also help determine the severity of your cancer.
    Be sure to follow your doctor's instructions . Keep the surgical area clean and dry. Ask your doctor about when it is safe to shower, bathe, or soak in water.
    If you develop complications from lymph node surgery, you will need to take some special precautions:
    • Do not have blood pressure taken, blood drawn, or shots given in that arm.
    • Wear gloves to do dishes, household scrubbing, and yard work.
    • Do not wear anything tight on that arm, including elastic in sleeves.
    • Do not carry heavy packages, purses, suitcases, or grocery bags with that arm.
    • Keep the skin of that arm well-moisturized with a lanolin-containing product.
    • Use an electric shaver if you want to shave your armpits.
    • If you had lymph nodes in your armpit removed during breast cancer surgery, participating in a physical therapy program may help to prevent lymphedema.

    Call Your Doctor

    After arriving home, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
    • If lymph nodes were removed: redness, warmth, swelling, stiffness, or hardness in the extremity
    • Fingers and toes should always be warm and pink. Call your doctor if they become dusky or swollen.
    • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which last for more than two days after discharge from the hospital
    • Pain that you cannot control with the medicines you have been given
    • Cough, shortness of breath, or chest pain
    • New, unexplained symptoms
    If you think you have an emergency, call for medical help right away.

    RESOURCES

    American Cancer Society http://www.cancer.org/

    National Cancer Institute http://www.cancer.gov/

    CANADIAN RESOURCES

    Canadian Cancer Society http://www.cancer.ca/

    Health Canada http://www.hc-sc.gc.ca

    References

    Dauway EL, Giuliano R, Haddad F, et al. Lymphatic mapping in breast cancer. Hematol Oncol Clin North Am . 1999;13:349-371.

    Leong SP. The role of sentinel lymph nodes in malignant melanoma. Surg Clin North Am . 2000;80:1741-1757.

    Sentinel lymph node biopsy: questions and answers. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/factsheet/Therapy/sentinel-node-biopsy . Accessed January 2, 2013.

    Veronesi U, Paganelli G, Viale G, et al. Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomized controlled study. Lancet Oncol . 2006;7:983-990.

    1/22/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Torres Lacomba M, Yuste Sánchez MJ, Zapico Goñi A, et al. Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial. BMJ . 2010;340:b5396.

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