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

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 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:

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.

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 persist 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 911.

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.

Last reviewed November 2009 by B. Gabriel Smolarz, MD

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