Sentinel Node Node Identification

Surgeons are now using a less invasive method to determine if breast cancer has spread beyond the breast.


Breast cancer can spread through the lymph ducts and lymph nodes to other areas of the body. In order to determine if the cancer has spread, and to determine how aggressive treatment needs to be, surgeons remove the lymph nodes under the arm.


The new, less-invasive procedure, called sentinel node biopsy, causes fewer complications and side effects than traditional axillary lymph node dissection.


With traditional axillary lymph node dissection, the surgeon makes an incision underneath the arm and removes the bulk of the lymph node tissue that drains from the breast. On average, 10 to 15 lymph nodes are removed, and the tissue is then sent to the laboratory where a pathologist looks at the lymph nodes to determine if any of them contain cancer.


Through sentinel node biopsy, the surgeon only removes 1 to 3 lymph nodes. The sentinel lymph node is the first node that filters fluid from the breast, and experts believe that malignant cells reach the sentinel node first. If the sentinel is free of cancer cells, it is unlikely that the other nodes are positive.


When more lymph nodes are removed, there’s a greater chance for arm swelling, decreased mobility, pain and numbness and nerve injury. Furthermore, axillary node dissection usually requires an overnight stay at the hospital, whereas sentinel node biopsy does not.


Sentinel node biopsy also can lead to a more accurate assessment of whether cancer has spread. In a traditional axillary dissection, the pathologist makes fewer cuts in each of the lymph nodes to look for cancer. When the pathologist receives only the sentinel node, he or she makes many cuts through the node to look for cancer. This also gives them the capability to use more highly specific stains.


If the sentinel node is negative, there is a greater than 95 percent chance that the other lymph nodes are also cancer free. If the results are positive, the surgeon may then perform an axillary node dissection to see how many other nodes are affected.


With increased screening, we are finding smaller cancers sooner, which means less chance of cancer spreading to the lymph nodes. Therefore, a higher number of axillary dissections are going to be negative. The sentinel node biopsy eliminates unnecessary surgery and risks.


Sentinel node biopsy is covered by Medicare and most private insurances.