Sentinel Node Biopsy

Sentinel Node Biopsy (SNB) is a special type of biopsy. It is used to see if breast cancer has spread outside of the breast area, to the lymph nodes. I had SNB in 1998. During that time period, it was still considered an experimental procedure at the hospital where I had my surgery. I consented to be part of the "trial" and my SNB was followed by axillary dissection, or the removal of the lymph nodes.

SNB is a fairly new diagnostic tool to help determine the "staging" of your breast cancer. We will talk in detail about staging in a later article. Generally, your cancer is determined to be Stage I, II, III or IV, with I being the least complicated. Before the onset of SNB, most women had to undergo the removal of most of their underarm lymph nodes. The lymphatic system is the body's plumbing plant. It is responsible for the drainage of the lymph fluid. The "sentinel node" is the first lymph node that collects fluid from the breast tissue. If you visualize the lymph nodes as the pipes under your kitchen sink, it is a bit easier to understand. Before any clogs can get from your sink to the pipes that go out to the sewer or cesspool, the clog has to go down the drain and through the main pipe, which branches off into the other pipes. That main drainpipe is the sentinel node. The theory behind this procedure is that if the first node is negative for cancer, than the remaining nodes SHOULD be clear.

The procedure is generally done when you are having another type of breast surgery, such as a lumpectomy. You will be injected with either a radioisotope, or tracer, and/or a neon blue dye. You have to wait a while for your body to absorb the materials. In my case, I was injected by a nuclear medicine resident, waited about one hour (I'm not positive of the time frame), and then went to the operating room. In the operating room, I was scheduled for a Sentinel Node Biopsy, a wide excision (fancy name for a larger lumpectomy) and an axillary dissection.

Since the procedure was still in the testing phase, the head of the breast surgery team at my hospital did the SNB. I was attached to an IV, lightly sedated and was aware of my surroundings, in a kind of drug-induced haze. The doctor waved this wand around my arm. The wand was attached to a small machine that resembled an applause meter. (That gives away my age!) The general reference states that it is similar to a Geiger counter. When my underarm started clicking, the surgeon proclaimed that he had found the sentinel node and the surgical team removed it. (I was hoping for a little drama and a cry of "Eureka!").

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