SURGERY OPTIONS

Sentinel Node Biopsy

Whether a woman has had a radical or modified radical mastectomy, or a lumpectomy, her physicians need to know whether the cancer has spread to the lymph nodes, a jumping-off point from which cancer cells can then spread throughout the body.

Surgeons once believed that removing as many lymph nodes as possible would reduce the risk of distant metastasis and improve the chances of a cure. We now know that systemic treatment offers the best prospect of wiping out cancer cells that have spread beyond the breast.

Removing the lymph nodes under the arm is in fact the most difficult part of the surgery a patient must deal with. A revolution in the surgical management of breast cancer patients is that we can now identify through a small biopsy, those patients who actually need the lymph node dissection. Since 60% of our patients do not have spread to their lymph nodes, sparing them an axillary dissection — removal of more lymph nodes in the axilla (armpit) — is a major breakthrough.

How does this work? A blue dye is injected around the tumor and is absorbed by the lymphatic pipes that then travel to the lymph nodes. The first lymph node — the sentinel node — that drains the tumor, the one most likely to contain spread if there has been any, turns blue from the dye, allowing the surgeon to identify and remove it. In experienced hands, the sentinel node is accurate at predicting the presence of disease in the remaining nodes greater than 98% of the time.

Our Breast Center surgeons have all gained expertise in this specialized technique and perform it on a regular basis. The Director of the Breast Center, Dr. Lorraine Tafra, has been performing sentinel node biopsy since 1992, has spearheaded research efforts to make it available to patients, and is the principle investigator of a large grant and clinical trial using the technique. No woman treated at the Breast Center undergoes an axillary dissection unless she really needs it.