a sentinel lymph node biopsy there are three reasons to check lymph nodes

for any cancer but for breast cancer the reasons are to stage the patient

appropriately so we can predict

survival and outcome The second reason then is to determine treatment

based on that stage

of a patient and the third reason is to

remove cancer cells and decrease the amount tumor

by actually physically removing the lymph nodes that may harbor tumor cells

Our body contains two separate systems for transporting fluids

The circulatory system and the lymphatic system The more familiar circulatory

system transports blood

The lymphatic system is composed of lymphatic vessels and lymph nodes which

are collections

of grape like structures The lymphatic system

transports lymph, a colorless fluid and lymphocytes

specialized cells of the immune system Like small streams merging to form a

river

small lymph ducts merge into increasingly larger lymph vessels

that ultimately empty into the bloodstream the lymphatic system serves

many purposes including

the filtration of foreign objects like bacteria, fluid transport

and the initiation of the immune response the lymphatic system is also where

cancer cells can drain

collect and gain access to other parts of the body

Lymphatic fluid actually bathes the breast and then drains through lymphatic channels much

as

rivers would drain into a larger body of water

so these channels then drain into one or two or three or four lymph nodes

and with certain die injecting techniques we're able to identify those

important drainage lymph nodes

and the theory behind sentinel lymph node is if we check

those first and they do not harbor any tumor

if there's no tumor in those lymph nodes then we don't have to remove

more lymph nodes in that particular patient

The technique of sentinel lymph node mapping involves injecting a dye

and one can either use two different types of dye

a radioactive dye called technetium sulfur colloid

and/or a blue dye called isosulfan blue

or methylene blue It's very appropriate to use one or two

or both it just depends on that particular surgeons training and

abilities

to find the sentinel lymph node In the blue dye technique

a small amount of blue dye is injected into the breast near the tumor

the dye spreads rapidly through the region after five to 10 minutes

it will have traveled to the lymphatic vessels in the area A blue stained vessel

is found and followed until the lymph nodes are reached

The blue stained nodes closest to the tumor are the sentinel nodes

The sentinel nodes are then removed and examined for the presence of cancer

cells

In the radioactive colloid technique,

a small amount of radioactive material is injected into the breast

4 to 6 hours before surgery After sufficient time had elapsed

A surgeon uses a special handheld detector to identify the areas

emitting high levels of radiation These areas contain lymph nodes that have taken

up larger amounts of the radioactive material These notes with high levels of

radiation

are called hot nodes and sometimes that is done the day before or the day of

surgery

so the patient would have to come in the day before perhaps

and get that injection which would be injected

around the tumor or around the nipple area or a complex

The amount of radioactive dye that we use for this procedure

is very minimal and it's quite safe to be around other people and being around

your children

traveling in your car on the bus and be next to people it's very similar to

the amount

used in a bone scan

In the operating room after we

identified the lymph nodes and removed them some surgeons will send them right

away to pathology to examine

by a frozen section to see if there are tumor cells

in those lymph nodes because if there are tumor cells in the lymph nodes then

again some surgeons that same day

will go ahead and perform a complete axillary lymph node dissection

in order to determine whether they're other lymph nodes involved

in that particular patient The side effects of sentinel lymph node biopsy are usually

limited to tenderness around the area of surgery that should subside with time

other more serious side effects that can occur include numbness,

limited range of motion, infection and Lymphedema

these side effects are less common but they may occur and can have lasting

implications on your daily life For more information on breast cancer please go

to www.cancerquest.org

www.cancerquest.org