Keeping Guard Over Your Future

Sentinel node biopsies can help lower the risk of lymphedema for some patients

The first step in completing a sentinel node biopsy for breast cancer patients undergoing surgery is an imaging procedure called lymphoscintigraphy. Because of the pain it causes, this first step is also the hardest one. RaDonna Pirkle, a physician’s assistant for Savannah Chatham Imaging who administers the injections for this procedure, notes that it will cause a short but sharp burning sensation. However, the information gained from this process can provide a lasting benefit to some breast cancer patients: less surgery and less risk for lymphedema.

“If breast cancer gets into the lymphatic system, it’s going to drain to the closest lymph node, known as the sentinel node,” Pirkle says. “With lymphoscintigraphy, we inject radioactive material into the breast, and through imaging we find where that lymph node is located. We can also follow the second and third lymph nodes.”

“We mark the area for the surgeon, who removes that first lymph node closest to the cancer and tests it for cancer spread,” Pirkle says. “This test is the sentinel node biopsy. If the lymph node is negative, the surgeon knows the cancer has not spread, and he or she will not need to do any further surgery beyond the lumpectomy or mastectomy that was originally planned.”

Without this confirmation from the sentinel node biopsy, a surgeon would have to complete what is known as a full axillary dissection, cutting further up the lymphatic channel to test more lymph nodes. This surgery puts the patient at greater risk for lymphedema, in which the lymph channels are impaired and the lymph fluid collects in the tissues of the affected area. The fluid builds up and causes heavy swelling that, if not treated properly, can lead to disfigurement, infection, and even disability. Lymphedema has no cure, though it can be managed. It is unfortunately a common side effect of cancer treatments that require the removal or the impairment of lymph nodes.

The patient’s physician decides if she is a candidate for a sentinel node biopsy. Pirkle takes care to make her part, the lymphoscintigraphy, as smooth as it can be, conceding that there will be a few seconds of pain.

“The injections do burn, but the pain goes away quickly,” she says. “The thing to remember is that for a woman whose cancer has not spread to the lymph nodes, this procedure can spare her from further surgery and its long-term effects.”
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