What is Sentinel Lymph Node Biopsy

Sentinel lymph node biopsy is a procedure to identify, remove, and examine one or more lymph nodes for cancer. Lymph is fluid from the tissues in your body. It is removed through the lymphatic system.

This system is part of your body’s defense system (immune system) and includes lymph nodes and lymph vessels. Certain types of cancer can spread to nearby lymph nodes.

The cancer usually spreads to one lymph node first, and then to others. The first lymph node that the cancer could spread to is called the sentinel lymph node. In some cases, there may be more than one sentinel lymph node.

You may have this procedure to determine whether your cancer has spread and to help your health care provider plan your treatment. If no cancer is found in the sentinel lymph node, it is very unlikely that the cancer has spread to any of your other lymph nodes in the body.

If cancer is found in the sentinel lymph node, your surgeon may remove additional lymph nodes for examination.

Tell a health care provider about:

• Any allergies you have, including any history of problems with contrast dye.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reaction to medicines or dyes.
• Staining of the skin where the dye is injected.
• Damaged lymph vessels, causing a buildup of fluid (lymphedema).
• Pain or bruising at the biopsy site.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods, such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• Taking over-the-counter medicines, vitamins, herbs, and supplements.

General instructions

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. Stop any use of these products at least 2 weeks before the procedure. If you need help quitting, ask your health care provider.
• You may have blood tests to make sure your blood clots normally.
• Plan to have someone take you home from the hospital or clinic.
• Ask your health care provider what steps will be taken to prevent infection. These may include:
  • Removing hair at the surgery site.
  • Washing skin with soap.
  • Taking antibiotic medicine.

What happens during the procedure?

• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
• Blue dye, a radioactive substance, or both will be injected around the tumor.
  • The blue dye will reach your lymph node quickly. It may be given just before surgery.
  • The radioactive substance will take longer to reach your lymph nodes. It may be given 2–24 hours before surgery, depending on your hospital.
• Both the dye and the radioactive substance will follow the same path that a spreading cancer would likely follow.
• If a radioactive substance was injected, a scanner will show where the substance has spread. This will help identify the sentinel lymph node.
• The surgeon will make a small incision. If blue dye was injected, your surgeon will look for any lymph nodes that have picked up the dye.
• Sentinel lymph nodes will be removed and sent to a lab for testing.
  • If no cancer is found, no other lymph nodes will be removed. It is unlikely the cancer has spread.
  • If cancer is found, the surgeon will remove other lymph nodes for testing. This may happen during the same procedure or at a later time.
• The incision will be closed with stitches (sutures) or skin glue.
• Small adhesive bandages may be used to keep the skin edges close together.
• A small dressing may be taped over the incision area.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.
• Your urine or stool may be blue for the next 24–48 hours. This is normal. It is caused by the dye that is used during the procedure.
• It is up to you to get the results of your procedure. Ask your health care provider, or the department that is doing the procedure, when your results will be ready.

Summary

• A sentinel lymph node biopsy is a procedure to identify, remove, and examine one or more lymph nodes for cancer.
• If you have cancer, you may have this procedure to determine whether your cancer has spread.
• If no cancer is found in the sentinel lymph node, it is very unlikely that the cancer has spread to any other lymph nodes. If cancer is found in the sentinel lymph node, your surgeon may remove additional lymph nodes for examination.

Sentinel Lymph Node Biopsy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Blue urine or stool for the next 24–48 hours. This is normal. It is caused by the dye used during the procedure.
• Blue skin at the injection site. This may last for up to 8 weeks.
• Numbness, tingling, or pain near your incision site.
• Swelling or bruising near your incision.

Follow these instructions at home:

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may be able to shower 24 hours after your procedure. After a shower, pat the incision area dry with a clean towel. Do not rub the incision. That could cause bleeding.

Activity

• Avoid activities that take a lot of effort.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• You may resume your regular diet.
• If the procedure was done on or near the lymph nodes under your arm (axillary lymph nodes), do not have your blood pressure taken or have blood drawn from the arm on the side of the biopsy until your health care provider says it is okay.
• You may need to be screened for extra fluid around the lymph nodes (lymphedema). Follow instructions from your health care provider about how often you should be checked.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Your pain medicine is not helping.
• You have more redness, swelling, or pain around your biopsy site.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You have nausea and vomiting.
• You have any new bruising.
• You have chills or a fever.

Get help right away if:

• You have pain that is getting worse, and your medicine is not helping.
• You have vomiting that will not stop.
• You have chest pain or trouble breathing.

Summary

• After the procedure, it is common to have blue urine or stool for the next 24–48 hours.
• Follow instructions from your health care provider about how to take care of your incision. Check your incision area every day for signs of infection.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Ask your health care provider when you can return to your normal activities.