Lymph Node Biopsy

Has Breast Cancer Spread to Your Lymph Nodes?

Your breast cancer surgeon and medical oncologist may talk about lymph node involvement. This refers to whether cancer has spread to the nearby lymph nodes. To determine if cancer cells are present in the lymph nodes, a Rocky Mountain Breast Specialists (RMBS) breast surgeon will remove one or several underarm lymph nodes so they can be examined under a microscope. This is often done at the same time as the breast cancer removal surgery, or it can be done as a separate procedure.

The results of the biopsy will be a part of the breast cancer staging process.

Lymph nodes can be checked in two different ways. The most common and least-invasive method is called sentinel lymph node biopsy. The other is called axillary lymph node dissection.

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Sentinel Lymph Node Biopsy (SLNB)

The sentinel lymph node is the lymph node that’s most likely to have cancer spread to it first. A sentinel lymph node biopsy (SLNB) is a surgical procedure that identifies the sentinel lymph node so it can be removed and examined to determine whether cancer cells are present. 

During this procedure, your surgeon will inject a blue dye or a radioactive substance (or both) near the breast tumor. Then, using a scanner that detects the radioactive material or by looking for the blue dye, the surgeon can tell which is the sentinel lymph node. It’s removed and checked for cancer cells by a pathologist.


Understanding SLNB Results

The pathology report gives your oncologist important information that can help determine the stage of breast cancer as well as any additional testing that needs to be done to create the rest of the breast cancer treatment plan. 

If no cancer is found the result is “lymph-node negative.” This means it’s unlikely that the cancer has spread to nearby lymph nodes. 

If cancer is found in the sentinel lymph node, the result is “lymph-node positive.” In this case, more lymph nodes may be removed to determine how far cancer has spread into the lymph nodes. 

Axillary Lymph Node Dissection (ALND)

The axillary lymph nodes run from the breast tissue into the armpit. This area under the arm is called the axilla.

During a traditional axillary lymph node dissection (ALND), anywhere from 10 to 40 lymph nodes are removed and examined. These nodes are typically removed during your lumpectomy or mastectomy.

Sometimes, a targeted axillary lymph node dissection (TAD) will be performed. TAD involves marking metastatic nodes with clips so that selected nodes can be removed after chemotherapy for further pathology evaluation of residual nodal involvement. 

Patients who have axillary lymph node dissections are more likely to develop a condition called lymphedema that causes fluid to build up in the arm near where the lymph nodes were removed. This can be treated and even prevented with special care.

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