Sentinel Lymph Node Biopsy Overview

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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 © 2009 Nucleus Medical Media, Inc.

Prior to Procedure

Your doctor will do a physical exam. The cancerous tissue will be biopsied. Tests may include the following:

• Blood tests
• Urine tests
• A mammogram , in cases of breast cancer
• CT scan —type of x-ray that uses a computer to produce cross-sectional images of the inside of the body
• MRI scan —a test that uses magnetic waves to make pictures of structures inside the body

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 (Plavix) or warfarin (Coumadin)

• The night before, eat a light meal. 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. The doctor will make a small incision. The sentinel node (or nodes) will be removed. The removed node will be checked for cancer cells. If cancer is found, the doctor will remove the rest of the lymph nodes in that area.

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.

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, grocery bags, etc. with that arm.
• Keep the skin of that arm well-moisturized with a lanolin-containing product.
• Use an electric shaver if you wish 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.

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/index-eng.php

References:

Abeloff M. Clinical Oncology. 2nd ed. New York, NY: Churchill Livingstone, Inc.; 2000.

Alazraki NP, Styblo T, Grant SF, et al. Sentinel node staging of early breast cancer using lymphoscintigraphy and the intraoperative gamma detecting probe. Radiol Clin North Am. 2001;39:947-956.

American Cancer Society website. Available at: http://www.cancer.org .

Conn HF, Rakel R. Conn’s Current Therapy. 54th ed. Philadelphia, PA: WB Saunders Company; 2002.

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 July 21, 2009.

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.