Sentinel Lymph Node Biopsy
A sentinel lymph node biopsy is a diagnostic surgical procedure performed to determine whether cancer has spread into the lymphatic system from its original site. The sentinel node is the first node to which the cancer spreads after leaving its site of origin.
Reasons for a Sentinel Lymph Node Biopsy
A sentinel lymph node biopsy can be used to diagnose the spread of the following cancers:
- Breast cancer
- Head and neck cancer
- Thyroid cancer
- Non-small cell lung cancer
- Stomach cancer
- Colon cancer
- Vulvar cancer
- Endometrial cancer
- Cervical cancer
In the case of breast cancer, the sentinel node is located under the arm and is the first node that drains fluid from the breasts. Because of its position, many doctors believe that, if cancer spreads beyond the breast, the sentinel node is the first place it would appear, and that, if there are no cancerous cells in the sentinel node, the cancer has likely not spread beyond the breast.
Lymph Node Dissection
Lymph node dissection is a surgical procedure in which lymph nodes are removed from the armpit or groin area to check whether a cancer has spread from its original site to an adjacent area. Since cancer often spreads to the nearby lymph nodes before it spreads to anywhere else in the body, the lymph node dissection can show whether the malignancy has traveled from its original site. Cancers that have a marked tendency to move to the lymph nodes include melanoma, head and neck cancers, colorectal cancer, gastric cancer, and cancers of the breast, thyroid and lung.
Lymph Node Dissection Procedure
Lymph node dissection takes about one hour, and is usually performed under general anesthesia.
An incision, no longer than three inches wide, is made in the armpit or groin and a group of lymph nodes are removed for tissue analysis. The incision is then closed with stitches, and a bandage is placed over the incision site. Tissue from the lymph nodes is sent to the lab for further analysis and a full pathology report is usually available a few days later.
Risks of Lymph Node Dissection
While lymph node dissection is a safe procedure, there are risks associated with any surgical procedure. These may include:
- Excessive bleeding
- Allergic reaction to anesthesia
- Tingling, numbness or weakness of the arm or leg
- Loss of sensation in the armpit or groin
- Development of deep vein thrombosis (DVT)
- Infection at the site of the incision
Signs of infection, including the following, require immediate medical intervention, usually the administration of antibiotics.
- Fever (temperature greater than 101 degrees Fahrenheit)
- Severe pain or pain that lasts more than 48 hours
- Oozing at the incision site
Recovery from Lymph Node Dissection
Patients return home the day of the procedure and most regular activities can be resumed the next day. The patient may experience tenderness and swelling at the incision site, but this usually dissipates after a few weeks. It is important to follow medical instructions for proper healing, which include:
- No strenuous exercise or heavy lifting
- Mild exercise of the affected area
- Avoiding removal of body hair from the affected area
- No deodorant or powder at the incision site
A biopsy is a minimally invasive procedure that removes a sample of abnormal tissue to determine whether it is benign or malignant. A biopsy can be performed on many different areas of the body, but is commonly used to diagnose, and sometimes treat, lumps found in breast tissue.
A breast biopsy may be performed after abnormalities have been detected during a self-exam, or after a mammogram or other imaging test has been performed. Other than surgical biopsy, there are several different types of biopsies available for removing abnormal tissue. Many of these procedures are performed with ultrasound or MRI guidance to ensure precise needle placement and minimal damage to surrounding healthy tissue.
The Benefits of Breast Biopsy
A breast biopsy allows for a determination to be made as to whether abnormal tissue is cancerous or noncancerous.
In addition to its diagnostic purpose, a biopsy can remove small tumors or other abnormalities that are found during the procedure, eliminating the need for additional surgery. Patients benefit from shorter recovery times and less surgical trauma. Removal through biopsy also saves a patient money by diagnosing and treating her condition in one simple procedure.
The Breast Biopsy Procedure
During a breast biopsy, the patient usually lies on her stomach on a special examination table with openings that allow access to the breasts. The procedure is performed from below the table. A biopsy may also be performed with the patient sitting upright in a chair.
Breast biopsy is performed on an outpatient basis using local anesthesia. A core needle biopsy removes only one sample of breast tissue per needle insertion, while a vacuum-assisted biopsy can collect multiple samples from a single insertion. The removed breast tissue is sent to a lab for review under a microscope, and results are usually available after 1 to 2 days. Most procedures take less than an hour to perform, and patients can return home shortly thereafter.
Pressure or mild discomfort may be experienced during the exam; numbness may be experienced afterward as the anesthesia wears off. There is no suturing needed after a breast biopsy because the incision is so small. Patients can usually return to work and other regular activities after a minimal recovery period.
Types of Breast Biopsies
There are several types of needle biopsies, each specialized to test a particular type of abnormality.
Core Needle Breast Biopsy
A core needle breast biopsy is recommended when a nodule is seen only or most clearly with ultrasound. Local anesthetic is applied, a small incision is made and the ultrasound-guided needle is inserted. Small pieces of affected tissue are removed swiftly and painlessly, and sent for testing.
Sonotome (ultrasound-guided) biopsy is a 10- to 15-minute procedure performed with local anesthesia and a Mammotome® (vacuum-assisted) needle inserted through a small incision in the skin. Tissue samples are taken, and a titanium clip is inserted to mark the location in case surgery is required. Typically, the entire abnormality is removed.
Stereotactic Mammotome Biopsy
This type of biopsy is most often performed when a mass can be detected with mammography but not with ultrasound. This procedure involves compressing the targeted area with a paddle and administering local anesthesia before inserting a Mammotome (vacuum-assisted) needle. The abnormal tissue is removed swiftly and painlessly with suction. The entire abnormality is removed in most of these procedures.
Fine-Needle Aspiration Biopsy
During an aspiration procedure, a small needle is inserted to remove a sample of the abnormal tissue, without the need for anesthesia. This procedure is most often performed for very small masses, and can help determine if the abnormality is a fluid-filled cyst or a solid mass.
This 5-minute procedure drains fluid from a cyst (fluid-filled nodule) using an ultrasound-guided needle. Local anesthesia is usually not needed. An X-ray may be taken to ensure that the cyst has collapsed. The fluid is sent to pathology to confirm that it is benign. Results from the tests are usually available within 24 to 48 hours.
Breast cyst aspiration is a procedure performed to drain a fluid-filled pouch that has formed in breast tissue. The purpose of aspiration is to relieve symptoms, and to provide, if necessary, fluid for laboratory examination. Breast cysts are usually discovered by mammogram or ultrasound. Such cysts are common and may cause discomfort, but are usually benign. Because a small percentage of breast cysts are malignant, however, they must be checked carefully to see whether further treatment is required.
Breast cyst aspiration is performed using a fine needle. Frequently, the aspiration itself will remove enough fluid to promote healing in a benign cyst. At times, however, the cyst will refill and require another aspiration. Breast cyst aspiration is usually performed using local anesthetic applied at the site of the cyst. Once the area is numb, the cyst is injected with a fine needle, smaller than the needle used for blood withdrawal. An ultrasound is sometimes performed to obtain a better view of the cyst. An attempt will be made to drain the cyst using a syringe.
Cysts containing a watery fluid that disappears immediately after aspiration are usually noncancerous, requiring no further testing. If the cyst refills, if the fluid is bloody, or if there is solid tissue aspirated rather than fluid, a sample is sent to a lab for testing. The pathology results from cyst aspiration are rapidly available. Regardless of the results, a patient usually returns to her doctor for a follow-up visit about a month after the procedure.
Breast cyst aspiration is a safe procedure, with few associated risks. These include discomfort at the site, bruising and the possibility of infection where the needle was inserted.
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