Inflammatory Breast Cancer

Sentinel Lymph Node Biopsy

One of the first places breast cancer spreads is to the lymph nodes under the arm. Nearly all women with invasive cancer must have these nodes examined. Until recently, surgeons would remove as many lymph nodes as possible (axillary node dissection). However, this process may cause numbness and a serious swelling of the arm (lymphedema). The sentinel node biopsy makes it possible to check for cancer in the lymph nodes with less risk of numbness and lymphedema.

Enlarge

The sentinel nodes are the first lymph nodes to receive lymph drainage from the breast and are also the most likely nodes to contain cancer if it has spread. If a sentinel node is removed, examined, and found to be healthy, the chance of finding cancer in any of the remaining nodes is very small, and no other nodes need to be removed. This exam spares many women the need for a more extensive operation and greatly decreases the risk of complications.

To identify the sentinel lymph node or nodes two "tracers" are used. These tracers are materials that are injected in the breast and then flow through the lymph channels into the axillary lymph nodes. One tracer contains a small amount of radioactive material that is injected into the breast the day before or the day of surgery. The tracer travels through the lymphatic channels to the lymph node, where it becomes trapped. The surgeon then uses a hand-held Geiger counter to find any radioactive lymph nodes. The second tracer that may be used is a blue dye, which is injected into the breast while the patient is in the operating room. This dye is also taken up by the lymphatic channels and delivered to the lymph nodes. By following the dye, the surgeon can identify the first lymph node reached. In addition to radioactive or blue lymph nodes, any lymph node that feels suspicious will also be removed at the time of sentinel node biopsy.

Axillary Dissection

If a sentinel lymph node is found to contain cancer, the standard treatment is an axillary dissection to remove the remaining lymph nodes under the arm. The number of nodes removed varies from person to person but averages between 15 and 25. After removing the lymph nodes they will be examined under a microscope. If the lymph nodes do contain cancer, then the chances that the cancer has traveled to other parts of the body are greater, and other treatments may be recommended.