If you have been diagnosed with breast cancer and have been advised to have a sentinel lymph node biopsy, Dr Ali Rizvi can assess your individual circumstances and explain how lymph node surgery fits into your treatment plan.
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A sentinel lymph node biopsy, also called a sentinel node biopsy or SLNB, is a surgical procedure used to check whether breast cancer has spread to the lymph nodes.
The sentinel lymph nodes are the first lymph nodes to which lymphatic fluid from the breast is likely to drain. If breast cancer cells have travelled outside the breast through the lymphatic system, these nodes are among the first places they may be detected.
During the procedure, the sentinel lymph nodes are identified and removed so they can be examined by a pathologist.
The aim is to obtain important information about the stage and behaviour of the cancer while avoiding removal of more lymph nodes than necessary.
Sentinel lymph node biopsy is commonly performed as part of surgery for selected patients with early breast cancer.
A sentinel lymph node biopsy provides important information about whether breast cancer cells have reached the lymph nodes.
The result can help your breast cancer team determine:
The decision about lymph node surgery depends on the individual diagnosis, imaging, biopsy results and the overall breast cancer treatment plan.
A sentinel lymph node that is successfully identified does not necessarily contain cancer. It is the node most likely to be affected first and is therefore removed for detailed pathological examination.
Sentinel lymph node biopsy is commonly considered for people with early-stage breast cancer when the lymph nodes do not appear to contain cancer clinically or on initial assessment.
It may be performed during:
Whether SLNB is appropriate depends on the individual circumstances.
If lymph nodes are known or strongly suspected to contain cancer before surgery, a different approach to axillary lymph node management may be recommended.
Dr Rizvi will assess your breast cancer diagnosis, imaging, biopsy findings and treatment plan before recommending lymph node surgery.
The sentinel lymph node needs to be accurately identified before it can be removed.
This is usually achieved using lymphatic mapping.
A small amount of radioactive tracer may be injected around the breast cancer or nipple area. The tracer travels through the lymphatic system towards the first draining lymph nodes.
A nuclear medicine scan, known as lymphoscintigraphy, can then help identify the location of the sentinel lymph node.
During surgery, the surgeon may also use a handheld probe to detect the tracer.
In some cases, a blue dye may also be used to help identify the sentinel lymph nodes.
The exact technique used depends on the patient’s circumstances and the surgical and hospital protocols.
If you have been diagnosed with breast cancer and have been advised that sentinel lymph node biopsy may be required, a consultation can help you understand the procedure and how it fits into your overall treatment plan.
Sentinel lymph node biopsy is generally performed under a general anaesthetic.
The process may involve:
A tracer is injected and allowed to travel through the lymphatic system to the sentinel lymph nodes.
The surgeon uses the mapping information and, where appropriate, a handheld detection device or dye to locate the sentinel nodes.
A small incision is usually made in the armpit to remove the identified sentinel lymph nodes.
The removed lymph nodes are sent to a pathology laboratory where they are examined for cancer cells.
The number of nodes removed varies between patients.
The sentinel lymph node biopsy may be performed during the same operation as breast cancer surgery.
In many patients, sentinel lymph node biopsy is performed during the same operation as breast cancer surgery.
For example, it may be performed alongside:
Combining procedures can mean that the breast surgery and lymph node assessment are completed during the same anaesthetic.
Your recommended operation will depend on the type and stage of breast cancer, breast imaging, biopsy results and your individual treatment plan.
The removed lymph nodes are sent to a pathologist for microscopic examination.
The pathologist looks for evidence of breast cancer cells within the lymph nodes.
The report may identify:
Dr Rizvi will explain the pathology results and what they mean in the context of your breast cancer.
The result is only one part of the overall treatment decision.
A negative sentinel lymph node biopsy means that no cancer cells were identified in the sentinel lymph nodes examined.
When the sentinel nodes are negative, further removal of lymph nodes from the armpit is often not required.
However, your ongoing treatment will depend on the complete pathology report and other features of your breast cancer.
Your multidisciplinary breast cancer team may consider factors such as:
A positive sentinel lymph node biopsy means that cancer cells have been identified in one or more sentinel lymph nodes.
This does not automatically mean that all the lymph nodes in the armpit contain cancer.
The significance of the result depends on the amount of cancer present, the number of affected nodes, the type of breast cancer and the overall treatment plan.
Depending on the circumstances, your treatment team may recommend:
Current breast cancer management aims to avoid unnecessary lymph node surgery when it is safe to do so.
Dr Rizvi can discuss the pathology findings with you and explain what they may mean for your treatment.
Recovery following sentinel lymph node biopsy is generally quicker than recovery following a more extensive axillary lymph node dissection because fewer lymph nodes are removed.
You may experience:
Dr Rizvi will provide individual instructions about wound care, activity and returning to normal activities.
If sentinel node biopsy is performed together with breast surgery, your overall recovery will also depend on the type and extent of breast surgery performed.
Sentinel lymph node biopsy is generally considered a safe procedure, but as with any surgery, complications can occur.
Potential risks include:
The risk of lymphoedema is generally lower following sentinel lymph node biopsy than after removal of a larger number of axillary lymph nodes, although the risk is not zero.
Your individual risk depends on your breast cancer, previous treatment, the number of lymph nodes removed and whether additional axillary treatment is required.
Dr Rizvi will discuss the relevant risks with you before surgery.
Sentinel lymph node biopsy and axillary lymph node dissection are different procedures.
| Sentinel Lymph Node Biopsy | Axillary Lymph Node Dissection |
|---|---|
| Removes the first draining lymph nodes | Removes a larger number of lymph nodes |
| Used to assess whether cancer has spread | Used when more extensive lymph node surgery is clinically indicated |
| Usually involves fewer lymph nodes | Involves substantially more lymph node tissue |
| Generally has a lower risk of lymphoedema than full axillary surgery | Has a higher risk of lymphoedema |
| Often performed with breast cancer surgery | May be recommended when lymph node involvement requires more extensive treatment |
The appropriate approach depends on your individual breast cancer and the findings from your clinical assessment, imaging and pathology.
The goal of modern breast cancer surgery is to obtain the information needed to treat the cancer effectively while avoiding unnecessary surgery where it is safe to do so.
Sentinel lymph node biopsy is performed under anaesthesia, so you should not feel the operation itself. Some discomfort, tenderness or bruising around the breast or armpit can occur afterwards and is usually managed with appropriate pain relief.
The number varies between patients. Sentinel lymph node biopsy aims to identify and remove the first draining lymph node or nodes rather than removing all of the lymph nodes in the armpit.
The time required varies depending on whether sentinel node biopsy is being performed with breast cancer surgery and the complexity of the operation. Dr Rizvi can explain the expected operating time for your individual procedure.
Not everyone with breast cancer requires sentinel lymph node biopsy. It is commonly used for selected patients with early breast cancer when the axillary lymph nodes are not known to contain cancer. Dr Rizvi can assess whether it is appropriate based on your diagnosis and treatment plan.
Yes. Sentinel lymph node biopsy may be performed during a mastectomy when lymph node assessment is indicated.
Yes. Sentinel lymph node biopsy is commonly performed during breast-conserving surgery when lymph node assessment is indicated.
A positive result means cancer cells were found in one or more sentinel nodes. Depending on the amount of cancer present and your overall diagnosis, your treatment team may recommend further surgery, radiotherapy, systemic treatment or another management approach.
Yes, lymphoedema is a possible complication, although the risk is generally lower after sentinel lymph node biopsy than after more extensive axillary lymph node surgery.
There will usually be a small incision, commonly in the armpit. The appearance of the scar varies between patients and generally changes as it heals and matures.
A breast cancer diagnosis can make decisions about surgery feel overwhelming. Understanding why lymph node surgery is recommended and what the results may mean can help you approach treatment with greater clarity.
Dr Ali Rizvi provides specialist breast and cancer surgical care in Sydney, with an emphasis on evidence-based treatment, cancer safety and clear communication.
Visit our Surgery in Sydney page to explore all procedures and Breast Surgery options offered by Dr Ali Rizvi and learn how we can help you with your surgical care
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