Selective Sentinel Lymph Node Biopsy: what are its benefits?

Until the end of the last century, when a woman presented with breast cancer, she underwent surgery to remove all the axillary lymph nodes on the same side, because it was considered that they could facilitate the spread of the tumor. But in the 1990s what is known as the sentinel node was discovered, which is a nodal level that separates the breast nodes from the rest of the axillary nodes. If the sentinel node is free of tumor cells, the rest of the axillary nodes will also be free of tumor cells.

It was during those years when the selective sentinel lymph node biopsy began to be performed in Spain, which consists of locating this lymph node level, intervening by means of general surgery on the lymph nodes that form it and analyzing whether or not they contain tumor cells, before considering the removal of the rest of the axillary lymph nodes.

How are sentinel nodes located?

There are several methods for locating sentinel nodes. Among them, there are two techniques that can be used in combination or separately, and which have a high safety index for the patient.

One is the injection of a dye which is injected into the breast just before the operation. This dye stains the sentinel lymph nodes and makes it easier for the surgeon to distinguish them from the rest and remove them. On the other hand, a substance with traces of radioactivity can also be injected, which makes it possible to identify the sentinel lymph nodes so that the surgeon can intervene on them.

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The latter method requires the intervention of a nuclear medicine physician and a lymphoscintigraphy after injecting the radioactive substance and before the operation.

Who is the sentinel lymph node technique performed on?

Selective sentinel lymph node biopsy is performed in women with breast cancer who are going to undergo surgery, but in whom there is no evidence that the tumor cells have reached the axillary nodes. An ultrasound scan is used to study whether there are suspicious lymph nodes and, if so, they are analyzed in a biopsy. If the results are negative, the patient may be a good candidate for sentinel node intervention.

Complications of sentinel node excision

All operations involve some risk, and the same is true in this case. However, due to the simplicity of the surgery and its minimally invasive nature, the possible complications arising from the operation are minimal.

Even so, there is a possibility that the patient may suffer an infection of the surgical wound or that a hematoma may appear. There may also be an accumulation of lymphatic fluid, slight lymphedema, scar retraction, allergy to any of the components of the method and discomfort or a feeling of tightness in the armpit, among others.

All these possible complications are much more infrequent than the effects of removing all the axillary nodes.