Your Health - Sentinel Lymph Node Biopsy

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 where cancer would spread to 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

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 which may include:

Infection
Bleeding or bruising
Scarring
Nerve damage
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 of long-term illness
Smoking
Poor nutrition
Use of certain medications
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:

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—lower body will be numbed

Description of the Procedure

A blue dye and often a radioactive tracer will be injected in 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 surgeon 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 surgeon 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. This entire cancer removal surgery takes longer.

Will It Hurt?

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

Post-procedure Care

Be sure to follow your doctor's instructions. Keep the surgical area clean and dry.

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.

If you've had lymph nodes removed from your armpit, your arm is at risk of fluid accumulation and swelling (lymphedema) and/or serious infection (lymphangitis). These complications are more common in patients who have had an axillary dissection than in those who have had sentinel node biopsy. If you do develop complications from lymph node surgery, you'll need to take some special precautions:

Don't have blood pressure taken, blood drawn, or shots given in that arm.
Wear gloves to do dishes, household scrubbing, and yard work.
Don't wear anything tight on that arm, including elastic in sleeves.
Don't 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.

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 can't control with the medications you were given after surgery, or which persist for more than two days after discharge from the hospital.
Pain that you can't control with the medications you've been given.
Cough, shortness of breath, or chest pain.
New, unexplained symptoms

In case of an emergency call 911 immediately.

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_e.html/

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.

Last reviewed November 2009 by B. Gabriel Smolarz, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.