How Are Lymph Nodes Evaluated?
Once you’ve decided on your surgical plan, whether it’s a lumpectomy or partial mastectomy or total mastectomy, part of the staging process is evaluation of the lymph nodes. That is done during the time of your surgery. We call that sentinel lymph node biopsy.
If you don’t have clinically positive lymph nodes, whether it’s from an exam or from a biopsy of that lymph node, we do a sentinel node biopsy. Basically what we’re looking for is, has cancer spread to your lymph nodes? It’s very important for staging and prognosis and it guides some treatment recommendations. That procedure is done at the time of your surgery.
A part of the evaluation is done an hour or two before your surgery. We do an injection into the breast, usually in the upper outer quadrant. It’s a nuclear dye. Most of us use technetium 99. It’s a nuclear dye that travels down your lymphatics and ends up in one of four of your lymph nodes. Because we’re anticipating that if cancer were to spread, it would go to those lymph nodes first.
Then you go on to surgery an hour or two after that injection. While you’re asleep, your surgeon will inject with a second dye. We call that the backup dye. It’s a blue dye. We either use lymphazurin blue, which is usually industry standard, or methylene blue. And that’s a dilated version of that. Those blue dyes also travel down the same lymphatics and go to a few of your lymph nodes.
While we’re in surgery, we use two processes. We use our vision and look for any lymph nodes that have taken up the blue dye, or we also have a little, what we call a little Geiger counter, or a little probe, that detects the nuclear uptake of a few of those lymph nodes. Those lymph nodes do not necessarily mean that you have breast cancer in those nodes. What we’re anticipating is that if cancer were to spread, it would go to those lymph nodes first. And those are the ones that we evaluate. Sometimes we evaluate those while you’re asleep in surgery, we call that a frozen section or a touch prep. And basically what that means is, we’re examining a quick check of that lymph node to see if there’s any lymph node involvement. Because you may need the lymph nodes removed if they are positive. If we have a low suspicion that lymph nodes are involved, we take those one to four lymph nodes and we send those to pathologists and they will evaluate those over the next couple of days and give us some results.
1. Once you’ve decided on your surgical plan, part of the staging process is evaluating the lymph nodes, which is sentinel lymph node biopsy.
2. This looks to see if the cancer spread to your lymph nodes, which affects treatment recommendations.
3. The procedure is done at the time of your surgery with an injection of a nuclear dye into the breast, usually in the upper outer quadrant to see if cancer has spread.
4. If we have a low suspicion that lymph nodes are involved, we send those lymph nodes to a pathologist to evaluate.