Breast Team
Incorporating hospital and community healthservices, teaching and research
This leaflet has been prepared to provide you with someinformation about Sentinel Node Biopsy. We hope this information will help answer some of your questions and concerns in addition to the on-going discussions that you have been having with the consultants and nurses involved in your care. We want you to understand the procedure so that you can make informed decisions about your care. If you have any worries please do not hesitate to ask.
What are lymph nodes and why are they important?
In the body a network of lymphatic vessels drains fluid and cells to the lymph nodes. The lymph or fluid from the breast tissue mostly drains into the lymph nodes situated in your armpit (also called axilla). These lymph nodes are designed to trap or filter foreign or abnormal cells (such as bacteria or cancer cells). Lymph nodes (glands) are concentrations of immune cells within the lymphatic system.
Sometimes cancer cells can pass through the nodes and spread to other parts of the body by travelling through the lymphatic vessels.
What is Sentinel Node?
The sentinel node is the first node or the first few nodes in the armpit to receive the lymph fluid draining from your breast. The number of sentinel lymph nodes can vary, in some cases there can be more than one sentinel node.
When treating breast cancer it is important to find out if the cancer has spread to the lymph nodes in the armpit. (fig.1). If the lymph nodes are affected your treatment plan may need to change.
Diagram showing sentinel node (Fig1) National Cancer Institute
What is a Sentinel Lymph Node Biopsy?
Sentinel Lymph Node Biopsy is a new and accurate technique to determine if cancer has spread to the lymphatic system. It is an operation to remove just the sentinel node or nodes. If these nodes do not contain cancer cells it means that the rest of the lymph glands in the armpit are very likely to be free of disease and do not need further treatment.
If these nodes do contain cancer cells, then further surgery is needed to remove the remaining nodes in your armpit so that we have done as much as possible to prevent the cancer from spreading.
Why do I need Sentinel Lymph Node Biopsy?
You have been diagnosed with breast cancer and have been advised to have some of the lymph nodes removed.
This is necessary for two reasons.
- Accurately staging your disease
- The information from the biopsy will help us plan the next stage of your treatment
“Sentinel node biopsy is an enormous advantage " said Professor Lesley Fallowfield of Cancer Research UK
How is the sentinel node located?
The procedure is called sentinel node mapping which basically means locating the sentinel nodes.
To identify the sentinel node two types of harmless dye are injected into the breast. These injections help to locate the lymph node closest to the tumour site (sentinel node).
The first step is a visit to the X ray department at The London Independent Hospital (map on page 10) where a small dose of harmless radioactive isotope (tracer) is injected (fig 2) at the edge of the areola (the darker skinned area around your nipple). The isotope is injected 16 - 24 hours before the operation. Scans are taken and a mark is made on the skin in your armpit. These marks are very important please take care not to wash them off.
You will be allowed to go home after the procedure which can take up to an hour.
The dose of radio-isotope is harmless and quickly flushes out of the body.
Diagram showing dye injection (Fig2) National Cancer Institute
If you have been given the scan films please bring them with you to Homerton University Hospital when you are admitted the next day.
The following day you come to Homerton University Hospital for the next step of the procedure which is carried out at the same time as your operation (lumpectomy/mastectomy).
During your surgery, a small amount of harmless blue dye called patent blue V is injected in the same area as your previous injection. The lymph fluid carries both the dye and tracer to the lymph nodes (sentinel nodes) in the armpit.
The surgeon then uses a special ‘gamma’ probe to identify the lymph nodes that have the radioactivity from the isotope injection and at the same time looks for the nodes with a blue colour. These are the sentinel nodes; some show both tracer and dye and some show one or the other.
The dose of radio-isotope is harmless and quickly leaves the body.
What happens in a Sentinel NodeBiopsy and Sampling procedure?
The area is identified by the skin mark and the ‘gamma’ probe and a small incision (cut) is made in your armpit (axilla). Guided by the probe and the blue colour (fig 3 and 4) the correct lymph nodes are removed so that the pathologist can examine them closely for the presence of cancer cells.
You will receive the results of your biopsy in your next outpatient appointment.
Diagrams showing Gamma Probe and blue colour (fig3) and showing identified sentinel nodes (fig4)
National Cancer Institute
Do I need to sign a Consent form?
This procedure is done under general anesthesia. Before the operation you will asked to sign a consent form agreeing for the procedure to take place.
You will have a small scar, and there may be some swelling and discomfort in your armpit after the operation.
The surgery/biopsy procedure can take up to an hourand is usually carried out at the same time as your breast surgery.
In some patients the sentinel node biopsy is carried out alone before receiving chemotherapy.
Who will perform my procedure?
This procedure will be performed by a breast surgeon who is a member of the Breast Cancer Team.
At Homerton University Hospital the breast surgeons are specially trained in how to perform this technique.
What happens after the procedure?
After the operation, it is possible that you may have one or two tubes left in place to drain fluid from under your armpit. These tubes stay in place for a few days and you may be discharged with them in place. Some patients may have to remain in the hospital with the drain due to medical reasons.
Your Breast Care Nurse will explain how you should keep a record of the discharged fluid from the drain and how to keep the drain clean. Once the fluid decreases or stops draining, your surgeon or breast care nurse will remove the drain tube in an outpatient appointment. Removing the tubes is usually not painful.
How long will I be in the hospital?
The length of time that you stay in hospital will depend on how you are feeling after your operation, the type of operation and your doctor's opinion.
When can I resume normal activities?
You can usually begin gentle work within a week or two after your operation.
It is not uncommon to feel a bit 'down' after any operation, so do ask your doctor or breast care nurse if you feel you need more psychological support.
What are the benefits and risks of a Sentinel Lymph Node Biopsy?
It is a safe method of biopsy. However as with any procedure there are associated benefits and risks as listed below:
Benefits:
- Minimal invasive and very accurate procedure
- Smaller scar and there may be no need for a drain
- Recovery is quicker
- Less swelling in your arm and shoulder (lymphoedema)
- May experience less pain
- Reduces risk of after effects of surgery:
- Seroma (accumulation of blood or fluid)
- Lymphoedema
- Numbness in the arm
- Unnecessary removal of normal glands or unaffected glands is avoided
Risks:
- Allergic reaction to the dye
- Rash or redness and itchy skin due to dye
- Some patients may look blue all over for a few hours or the skin of the breast may be tinted blue and this fades over few days to few months depending on the individual patient.
- Urine or bowel movement may be blue for 24 - 48 hours after surgery
- It is not suitable for everyone
- In 5% of cases disease can remain in the axilla after removing a clear sentinel node
- Sometimes sentinel node cannot be located
Health and Cancer Information Centre (Health Shop)
The Health Shop is a drop in Health and Cancer Information Centre, based at the main entrance of the hospital. It provides information and support on cancer and cancer related issues.
Macmillan Cancer Information Manager:
Tel No: 0208 510 5191
Email:
Website:
Homerton Hospital PALS (Patients Advice & Liaison Service)
PALS is based in the main reception of the hospital.
Email:
Tel: 020 8510 7315 (9am – 5pm)
PALS provides confidential information and support, helping you to sort out any difficulties or concerns you have whilst in hospital, guiding you through the different services from the NHS.
Further Information:
Breast Cancer Care
Provides information and support to those affected by breast cancer - women and men, their partners, families & friends. Produces a range of booklets and leaflets on Breast Cancer.
Kiln House 210 New Kings Road, London SW6 4NZ
Helpline:0808 800 6000 (10am- 5pm Monday to Friday & 10am-2pm Saturdays)
Email:
Website:
Breakthrough Breast cancer
Dedicated to saving lives by finding the causes of breast cancer, improving detection, diagnosis, treatment and services
Helpline No: 08080 100 200
Email:
Website:
Macmillan Cancerline
Free information and emotional support for people living with cancer.
Telephone translation service for those whose first language is not English.
89 Albert Embankment
London, SE1 7UQ
National Helpline No: 0808 808 2020
Website:
Related websites
www .cancerhelp.org.uk
Information checklist:
You may find this checklist helpful when thinking about the questions you want to ask your doctor. If there are answers you don’t understand, ask your doctor to explain again.
What type of breast cancer do I have?
What does false-negative rate mean?
- What if the sentinel node biopsy is positive?
- Is the use of the sentinel-lymph-node biopsy common?
- What happens if the sentinel node is negative and the
lymph nodes are positive?
- What support can I get during my treatment?
If English is not your first language or you have problems understanding this leaflet please let a member of staff know.
Important information
Please remember that this leaflet is intended as general information only. It is not definitive. We aim to make the information as up to date and accurate as possible, but please be warned that it is always subject to change. Please, therefore, always check specific advice on the
procedure or any concerns you may have with your doctor.
Hand Hygiene
In the interests of our patients the trust is committed to maintaining a clean, safe environment.
Hand hygiene is a very important factor in controlling infection. Alcohol gel is widely available throughout our hospitals at the patient bedside for staff to use and also at the entrance of each clinical area for visitors to clean their hands before and after entering.
Other formats
If you require this leaflet in any other format please speak to your clinical nurse specialist (Keyworker)
Reference
The following team members have been consulted and agreed this patient information:
Consultant, Clinical Nurse Specialist (Keyworker), Macmillan Cancer Information and Support Manager and Patient
Produced by: Breast Team
Reviewed: May 2014
Next date:May 2016
Homerton University Hospital NHS Foundation Trust
Homerton Row, London, E9 6SR
T 020 8510 5555
W
E
Map: The London Independent Hospital
Address: / 1 Beaumont Square, Stepney GreenLondon, E1 4NL
Telephone: / 02077802400
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