Standard management of breast cancer has virtually always included the removal of all the lymph glands under the arm . This is done to determine whether cancer has spread to them from the breast .

The major complication of this procedure is the risk of swelling of the arm which can occur in over 20% of cases and is permanent .

Nerve irritation can also result causing numbness in the area and sometimes pain . As breast cancers began to be diagnosed at an earlier stage , the risk of spread having occurred to these glands became much less , so no advantage was gained by removing them if they all proved to be normal .

The procedure of Sentinel Node Biopsy was developed to show whether sampling of the lowermost gland under the arm could give a reliable indication as to whether cancer spread had occurred.

In a sentinel node test, a special dye is used prior to the breast cancer operation to identify the first lymph glands/nodes to which the liquid flows. The assumption is that this is the first node to which cancer cells would also spread in the underarm area.

You will normally go in for a sentinel node test a few hours before your operation. The test is done in the Nuclear Medicine department where the dye is injected into the area around the tumour. The area is then massaged to encourage spread of this dye. A scan is then undertaken to confirm the spread of the dye and to identify the first gland to which this occurs, the "sentinel node".

During the breast cancer surgery procedure the sentinel node is found by a hand-held gamma probe, surgically removed and submitted for instant analysis (frozen section). If it is found to be clear of tumour cells the remaining nodes are not removed.

Key Points

Post operative treatment is based on the nature of the primary tumour and the final analysis of the sentinel node with extensive pathological review of it. Close clinical follow up visits are standard procedure after this operation as it is, after all, breast cancer surgery.