Sentinel Lymph Node Biopsy

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Sentinel Lymph Node Biopsy, Houston, TX, Greater Houston Breast Care

A sentinel lymph node biopsy is a targeted, minimally-invasive procedure that determines if cancer has begun to spread beyond the breast. This essential test that stages the cancer is the gold standard in showing if and how far it has spread, and the results help establish the best next steps in treatment.(1)

Greater Houston Breast Surgeons is here to help you navigate your breast cancer treatment with confidence. We understand that a breast cancer diagnosis is frightening and choosing the best path can be confusing. Our highly trained, expert surgeons will support you every step of the way in understanding your options to effectively treat the cancer while preserving your quality of life and appearance.

Schedule your consultation today to explore your options. To schedule, contact us online or call our offices directly at (713) 701-7165.

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About Sentinel Lymph Node Biopsy

Breast cancer is the most frequently diagnosed cancer in women worldwide, and sentinel lymph node biopsies are the most accurate detection and staging tool. (2,3) Lymph nodes are small, round organs that play a critical role in the immune system. They are interconnected throughout the body and filter out harmful substances, like bacteria, viruses, and abnormal cells, to help the immune system fight diseases.

Many types of cancer, including breast cancer, spread through the hundreds of lymph nodes in the lymphatic system. The sentinel lymph node is located closest to the primary tumor and is likely to be the first lymph node that the cancer reaches if it is spreading. It is the gatekeeper and first stop for the cancer cells to spread to. (4)

Your surgeon will identify and remove only the first few nodes for further evaluation. This allows for more accurate staging of your cancer so your treatment can be highly targeted and specific, allowing for better results and a quicker return to normal.

Benefits

Sentinel lymph node biopsies are usually the initial test in determining if breast cancer has spread. It offers many benefits over other diagnostic techniques, including:

  • Minimally-invasive to better preserve lymphatic function, reduce complications, and for a quicker recovery
  • Highly accurate results
  • Determines the stage of cancer and the extent of any spreading
  • Allows for detailed and highly personalized treatment planning for best results
  • Reduces risk of lymphedema (when the lymphatic drainage is disrupted and causes fluid accumulation and swelling) compared to traditional dissection techniques
  • More precise than imaging to detect spread, especially in early stages (I or II)
  • Prevents unnecessary lymph node removal

Candidates

Sentinel lymph node biopsies are commonly used for patients with early-stage invasive breast cancer and patients undergoing a lumpectomy to remove a tumor. It is a critical tool in diagnosing if and how far your cancer has spread so your treatment plan can be tailored for the most effective treatment.

Personal Consultation

Your personal consultation is the cornerstone of your breast cancer treatment. During this meeting, you will connect with your surgeon and carefully develop your customized treatment plan. Our goal is for you to make informed treatment decisions that will optimize your results and preserve your appearance and quality of life.

We will review your medical history, address your concerns, answer all questions, and make the complex medical information you are facing easier to understand. Your consultation will include a comprehensive physical examination, including imaging (such as mammogram, ultrasound, or MRI), to assess the tumor.

Thoroughly discussing your treatment options with your surgeon including the benefits and risks will help establish realistic expectations. Your treatment plan will be based on your specific needs and every aspect will be tailored to optimize your outcomes and recovery.

Explore your options and get the support you need throughout your treatment by scheduling your personal consultation by contacting us online or calling our offices at (713) 701-7165.

Preparation

The lead-up to your procedure can be stressful. Our supportive team will guide you through personalized instructions to help you safely prepare for your treatment. Preparations may include:

  • Reviewing your medical history
  • Adjusting your medications and supplements
  • Additional lab testing
  • Organizing a reliable ride home
  • Fasting briefly before your procedure
  • Abstaining from nicotine or alcohol use

Procedure

Your sentinel lymph node biopsy will begin by mapping the lymphatic system. Dye, radioactive tracing solution, or a combination of both will be injected near the tumor before the procedure so it has time to travel to the sentinel lymph nodes. It will trace the same general pathway cancer cells would take. Anesthesia throughout the rest of the procedure will make sure you stay comfortable. Next, your surgeon will locate the highlighted sentinel lymph node(s) with the dye/tracer. The blue dye will be visible to the eye and a handheld detector will locate the radioactive tracer. After identifying the node(s), your surgeon will make a small incision to precisely remove them. If a quick result test is being performed, they will wait for the results to confirm no additional nodes need to be removed. If needed, they will remove the additional nodes. Finally, they will carefully close the incision and bandage the treatment area. The lymphatic tissue will be sent to the lab where the pathologist, a doctor specially trained in tissue diagnostics, will closely examine the tissue for the presence of cancer cells.

When the sentinel lymph node biopsy is performed as a standalone treatment, patients usually return home the same day. A sentinel lymph node biopsy is frequently performed at the same time as the lumpectomy to remove the tumor. If it was performed in conjunction with other treatments or tumor removal, patients typically remain overnight in the hospital for monitoring.

Recovery

Side effects after a sentinel lymph node biopsy are usually mild, and you will feel close to normal in a few days. Your breast and underwarm may experience swelling, bruising, or tenderness. This typically resolves in a few days, and cold compression can make the area feel more comfortable in the meantime. There might be slight fluid buildup, called a seroma, which will dissipate on its own or can be drained by your surgeon. The injected tracer or dye will leave the body in 24 to 48 hours. Until then, your skin or urine may be bluish. The small incision takes about two weeks to heal, and the scar will continue to heal and fade with time.

Results

Timing

The timing of your results will vary depending on the specifics of your procedure and the complexity of tissue testing. Sometimes, a test called a “frozen section” is performed during the surgery and can quickly provide results and allow the surgeon to remove additional lymph nodes if necessary. Standard results usually take five to ten days for the pathologist to carefully examine the tissue under the microscope.

Positive Results

A positive result indicates that cancer cells are present in the tested sentinel lymph nodes. It does not necessarily mean the cancer is widespread, it means regional nodes need to be further examined. Using sentinel lymph node biopsy as the initial testing step allows your treatment protocols to be targeted and precise. Common next steps include removing additional nodes, targeted drug therapy, or systematic therapies (like chemotherapy or radiation)

Negative Results

Negative results mean that there is no sign of cancer in the sentinel lymph nodes. It is unlikely that it has spread further into the lymphatic system and the body.

Corresponding Procedures

A sentinel lymph node biopsy is a tool to provide all-encompassing care. Depending on the size of your tumor and your individual needs, your treatment plan may include other procedures in addition to your sentinel lymph node biopsy.

A lumpectomy removes the cancerous tumor and a small “margin” of healthy cells to ensure all of the abnormal cells have been removed. It preserves the rest of the breast tissue. Oftentimes, a sentinel lymph node biopsy is performed in conjunction with a lumpectomy to check if the cancer has spread.

Axillary Lymph Node Dissection is a more extensive procedure that removes a major portion of lymph nodes in the area near the tumor. Removing a larger volume of lymph nodes provides more complete staging and is used for larger tumors, if there is spread present, or if multiple lymph nodes test positive.

Cost of Sentinel Lymph Node Biopsy in the Greater Houston Area

Each breast cancer treatment plan is unique. The cost of your sentinel lymph node biopsy will vary depending on the specifics of the procedure. Once your treatment plan has been established, you will be provided with a comprehensive price estimate.

FAQ

What is a sentinel lymph node?

A sentinel lymph node is located next to the cancer tumor and is where cancer would likely first enter the lymphatic system if it begins to spread.

How does the lymphatic system spread breast cancer?

The lymphatic system is an interconnected network of organs (lymph nodes), vessels (the thin connecting tubes), tissues, and fluids that defends the body against illness and infections. Cancer cells do not stick together in the same way as healthy cells, and when some break away from the main tumor, they enter the lymphatic vessels and travel throughout the body’s network. Traveling through the lymphatic system is the primary way cancer spreads.

Is a sentinel lymph node biopsy painful?

During the procedure itself, you will be comfortably asleep under anesthesia. Afterward, there may be mild to moderate soreness or tenderness or the sensation of tightness.

Can a sentinel lymph node biopsy be done at the same time as my tumor removal?

Yes, it is common for sentinel lymph node biopsies to be performed in conjunction with tumor removal, either before or after the removal. It can also be done independently at a separate time.

How many lymph nodes are removed?

The least amount of lymph nodes as possible are removed. For 99% of patients, spread is detected in five or less lymph nodes. (5) Typically, one to three lymph nodes are removed.

What does a sentinel lymph node biopsy do?

A sentinel lymph node biopsy carefully removes the lymph nodes closest to the tumor that are the most likely for it to have spread to. They are inspected to determine if cancer cells have reached them or if the tumor is localized. It is a critical tool in staging the cancer (seeing how advanced it is) and determining the best course of treatment.

Is the radioactive tracer and dye safe?

The minimal amounts of tracer and or dye injected are safe and most patients have no adverse effects. Your skin or urine may be tinted blue for up to a couple of days following treatment. These markers allow your doctor to precisely identify which lymph nodes are closest in the cancer’s direct path into the lymphatic system.

Do I need a sentinel lymph node biopsy or an axillary lymph node dissection?

Both procedures examine the lymph nodes to determine if the cancer cells have spread. This is pivotal to properly stage the cancer and create a comprehensive treatment plan. A sentinel lymph node biopsy removes just a few lymph nodes (usually 1-5) while an axillary lymph node dissection removes significantly more (usually about 20-40). A sentinel biopsy is often the initial step as a minimally-invasive way to confirm that the cancer has not spread. If there is a presence of a larger tumor or indication of spreading to the lymph nodes then an axillary dissection may be needed.

References

  1. Dogan NU, Dogan S, Favero G, Köhler C, Dursun P. The Basics of Sentinel Lymph Node Biopsy: Anatomical and Pathophysiological Considerations and Clinical Aspects. J Oncol. 2019;2019:3415630. doi:10.1155/2019/3415630
  2. Amersi F, Hansen NM. The benefits and limitations of sentinel lymph node biopsy. Curr Treat Options Oncol. 2006;7(2):141-151. doi:10.1007/s11864-006-0049-y
  3. Manca G, Tardelli E, Rubello D, et al. Sentinel lymph node biopsy in breast cancer. Nuclear Medicine Communications. 2016;37(6):570-576. doi:10.1097/mnm.0000000000000489
  4. Kell MR, Kerin MJ. Sentinel lymph node biopsy. BMJ. 2004;328(7452):1330-1331. doi:10.1136/bmj.328.7452.1330
  5. Yi M, Meric-Bernstam F, Ross MI, et al. How many sentinel lymph nodes are enough during sentinel lymph node dissection for breast cancer? Cancer. 2008;113(1):30-37. doi:10.1002/cncr.23514