Reasons For Axillary Surgery
If breast cancer spreads from the breast, the most common route is the lymph nodes in the armpit[axilla]. As part of breast cancer surgery, we either do a sentinel lymph node biopsy[SLNB] i.e removal of the first draining lymph nodes or complete axillary dissection where some or all of the lymph nodes[glandes] from your axilla [armpit] are removed. All these lymph nodes are sent for histopathological examination for detailed testing. This helps us to decide if
Problems associated with axillary dissection
It also involes wound drains; a longer hospital stay and several weeks of arm exercises before the arm can be used normally again.
According to research, many times we have found that cancer has not spread to axillary lymph nodes. In order to reduce the problems associated with complete axillary dissection, we have come up with sentinel lymph node dissection which is now taken as standard of care.
What Happens If The SLNB Test Is Positive
If the sentinel lymph nodes shows presence of breast cancer cells, completion axillary dissection is performed.
What Does A Negative Sentinel Lymph Node Mean
If sentineal lymph nodes are negative for cancer cells then we conclude that in 98% of the cases further axillary dissection also it will be negative so we don’t proceed axillary dissection further ahead.
How Is The SLNB Done
SLNB is performed as an adjuvant to breast cancer surgery. Commonly used methods are
GAMMA PROBE METHOD
A radioisotope [technetium] is injected in the skin around the nipple area either the day before operation or on the morning of the operation. This tracer is carried by the lymph vessels to the sentinel lymph node. The node is located with the help of a gamma probe at the time of surgery.
BLUE DYE METHOD
During surgery, the surgeon injects small amount of blue dye the blue dye is picked by the sentineal lymph node and is coloured blue. Any excess blue dye is harmeless and will be excreted by the body. At times patient may pass blue coloured urine and blue coloured stool which stops after 3-4 days. Patient may have bluish tinge and may look weak. It may even leave a bluish bruise on the breast which gets washed away in several months.
CASES WHERE A SLNB WON'T BE PERFORMED
If sentineal lymph node cannot be detected after gamma probe/blue dye.
If patient has lymph node which are positive for cancer cells then axillary dissection is to be done.