Sentinel Lymph Node Biopsy in Breast Cancer Treatment

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What is Sentinel Lymph Node Biopsy in Breast Cancer Treatment

Sentinel lymph node biopsy is a procedure to identify, remove, and examine one or more lymph nodes for cancer. Lymph nodes are collections of tissue that filter infections, cancer cells, and other waste substances from the bloodstream. Cancer can spread to nearby lymph nodes.

It usually spreads to one lymph node first, and then it spreads 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.

If you have breast cancer, you may have this procedure to determine whether your cancer has spread. For breast cancer, a sentinel lymph node is usually in your armpit because that is where breast cancer tends to spread first.

If no cancer is found in a sentinel lymph node, it is very unlikely that the cancer has spread to any of the other lymph nodes. If cancer is found in a sentinel lymph node, your surgeon may remove additional lymph nodes for examination.

Tell a health care provider about:

  • Any allergies you have.
  • 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.
  • Allergic reactions to medicines or dyes.
  • Staining of the skin where the dye is injected.
  • Damaged lymph vessels, causing a buildup of fluid (lymphedema).
  • Damage to other structures or organs.
  • Pain, bleeding, or bruising where a lymph node was removed (biopsy site).
  • A false-negative biopsy. This is when cancer cells are not found in the sentinel node, but the cancer has spread to other nodes in the area.

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 before your procedure if your health care provider instructs you not to.
  • You may be given antibiotic medicine to help prevent infection.

General instructions

  • If you smoke, stop smoking at least 2 weeks before the procedure. This will improve your health after the procedure and reduce your risk of getting a wound infection.
  • You may have blood tests to make sure your blood clots normally.
  • You may be screened for extra fluid around the lymph nodes (lymphedema).
  • Plan to have someone take you home from the hospital or clinic.
  • Ask your health care provider how your surgical site will be marked or identified.

What happens during the procedure?

  • To reduce your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
  • You will be given one of the following:
    • A medicine to numb the area (local anesthetic).
    • A medicine to make you fall asleep (general anesthetic).
  • Blue dye or a radioactive substance or both will be injected around the tumor in your breast.
    • 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, so it may be given before you go into the operating area.
    • Both the dye and the radioactive substance will follow the same path that a spreading cancer would be likely to follow.
  • If a radioactive substance was injected, a scanner will show where the substance has spread to 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 examination.
    • If no cancer is found, no other lymph nodes will be removed. This means it is unlikely that the cancer has spread to other lymph nodes.
    • If cancer is found, the surgeon will remove other lymph nodes in the armpit for examination. This may happen during the same procedure or at a later time.
  • The incision will be closed with stitches (sutures) or metal clips.
  • 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 the medicines you were given have worn off.
  • Your urine may be blue for the next 24 hours. This is normal. It is caused by the dye that is used during the procedure.
  • Your skin at the injection site may be blue for up to 8 weeks.
  • You may feel numbness, tingling, or pain near your incision.
  • You may have swelling or bruising near your incision.

Summary

  • Sentinel lymph node biopsy is a procedure to identify, remove, and examine one or more lymph nodes for cancer.
  • If you have breast cancer, you may have this procedure to determine whether your cancer has spread.
  • If cancer is found in a sentinel lymph node, your surgeon may remove additional lymph nodes for examination.

Sentinel Lymph Node Biopsy in Breast Cancer Treatment, 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-colored urine for the next 24 hours. This is normal. It is caused by the dye that was used during the procedure.
  • Blue skin at the injection site for up to 8 weeks.
  • Numbness, tingling, or pain near your incision.
  • Swelling or bruising near your incision.

Follow these instructions at home:

Activity

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

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.
  • 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.
  • Check your biopsy site every day for signs of infection. Check for:
    • More redness, swelling, or pain.
    • More fluid or blood.
    • Warmth.
    • Pus or a bad smell.

General instructions

  • If you were given a surgical bra, wear it for the next 48 hours. You may remove the bra to shower.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • You may resume your regular diet.
  • 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:

  • 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 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

  • Follow instructions from your health care provider about how to take care of your incision.
  • 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.

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