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Sentinel Node Biopsy
Lymph Node Sampling
Patient Information
Breast Team
Incorporating hospital and community health services, teaching and research
This leaflet has been prepared to provide you with
some information about Sentinel Node Biopsy. We
hope this information will help answer some of your
questions and concerns in addition to the on-going
discussions that you have been having with the
consultants and nurses involved in your care. We want
you to understand the procedure so that you can make
informed decisions about your care. If you have any
worries please do not hesitate to ask.
What are lymph nodes and why are they
important?
In the body a network of lymphatic vessels drains fluid
and cells to the lymph nodes. The lymph or fluid from
the breast tissue mostly drains into the lymph nodes
situated in your armpit (also called axilla). These lymph
nodes are designed to trap or filter foreign or abnormal
cells (such as bacteria or cancer cells). Lymph nodes
(glands) are concentrations of immune cells within the
lymphatic system.
Sometimes cancer cells can pass through the nodes
and spread to other parts of the body by travelling
through the lymphatic vessels.
What is Sentinel Node?
The sentinel node is the first node or the first few
nodes in the armpit to receive the lymph fluid draining
from your breast. The number of sentinel lymph nodes
can vary, in some cases there can be more than one
sentinel node.
When treating breast cancer it is important to find out if
the cancer has spread to the lymph nodes in the
armpit. (fig.1). If the lymph nodes are affected your
treatment plan may need to change.
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Diagram showing sentinel node (Fig1) National Cancer Institute
What is a Sentinel Lymph Node Biopsy?
Sentinel Lymph Node Biopsy is a new and accurate
technique to determine if cancer has spread to the
lymphatic system. It is an operation to remove just the
sentinel node or nodes. If these nodes do not contain
cancer cells it means that the rest of the lymph glands
in the armpit are very likely to be free of disease and
do not need further treatment.
If these nodes do contain cancer cells, then further
surgery is needed to remove the remaining nodes in
your armpit so that we have done as much as possible
to prevent the cancer from spreading.
Why do I need Sentinel Lymph Node Biopsy?
You have been diagnosed with breast cancer and have
been advised to have some of the lymph nodes
removed.
This is necessary for two reasons.
 Accurately staging your disease
 The information from the biopsy will help us plan
the next stage of your treatment
“Sentinel node biopsy is an enormous advantage " said
Professor Lesley Fallowfield of Cancer Research UK
How is the sentinel node located?
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The procedure is called sentinel node mapping which
basically means locating the sentinel nodes.
To identify the sentinel node two types of harmless dye
are injected into the breast. These injections help to
locate the lymph node closest to the tumour site
(sentinel node).
The first step is a visit to the X ray department at The
London Independent Hospital (map on page 10) where
a small dose of harmless radioactive isotope (tracer) is
injected (fig 2) at the edge of the areola (the darker
skinned area around your nipple). The isotope is
injected 16 - 24 hours before the operation. Scans are
taken and a mark is made on the skin in your armpit.
These marks are very important please take care not to
wash them off.
You will be allowed to go home after the procedure
which can take up to an hour.
The dose of radio-isotope is harmless and quickly
flushes out of the body.
Diagram showing dye injection (Fig2) National Cancer Institute
If you have been given the scan films please bring
them with you to Homerton University Hospital when
you are admitted the next day.
The following day you come to Homerton University
Hospital for the next step of the procedure which is
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carried out at the same time as your operation
(lumpectomy/mastectomy).
During your surgery, a small amount of harmless blue
dye called patent blue V is injected in the same area as
your previous injection. The lymph fluid carries both the
dye and tracer to the lymph nodes (sentinel nodes) in
the armpit.
The surgeon then uses a special ‘gamma’ probe to
identify the lymph nodes that have the radioactivity
from the isotope injection and at the same time looks
for the nodes with a blue colour. These are the sentinel
nodes; some show both tracer and dye and some show
one or the other.
The dose of radio-isotope is harmless and quickly
leaves the body.
What happens in a Sentinel Node Biopsy and
Sampling procedure?
The area is identified by the skin mark and the ‘gamma’
probe and a small incision (cut) is made in your armpit
(axilla). Guided by the probe and the blue colour (fig 3
and 4) the correct lymph nodes are removed so that
the pathologist can examine them closely for the
presence of cancer cells.
You will receive the results of your biopsy in your next
outpatient appointment.
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Diagrams showing Gamma Probe and blue colour (fig3) and showing
identified sentinel nodes (fig4)
National Cancer Institute
Do I need to sign a Consent form?
This procedure is done under general anesthesia.
Before the operation you will asked to sign a consent
form agreeing for the procedure to take place.
You will have a small scar, and there may be some
swelling and discomfort in your armpit after the
operation.
The surgery/biopsy procedure can take up to an hour
and is usually carried out at the same time as your
breast surgery.
In some patients the sentinel node biopsy is carried out
alone before receiving chemotherapy.
Who will perform my procedure?
This procedure will be performed by a breast surgeon
who is a member of the Breast Cancer Team.
At Homerton University Hospital the breast surgeons
are specially trained in how to perform this technique.
What happens after the procedure?
After the operation, it is possible that you may have
one or two tubes left in place to drain fluid from under
your armpit. These tubes stay in place for a few days
and you may be discharged with them in place. Some
patients may have to remain in the hospital with the
drain due to medical reasons.
Your Breast Care Nurse will explain how you should
keep a record of the discharged fluid from the drain
and how to keep the drain clean. Once the fluid
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decreases or stops draining, your surgeon or breast
care nurse will remove the drain tube in an outpatient
appointment. Removing the tubes is usually not painful.
How long will I be in the hospital?
The length of time that you stay in hospital will depend
on how you are feeling after your operation, the type of
operation and your doctor's opinion.
When can I resume normal activities?
You can usually begin gentle work within a week or two
after your operation.
It is not uncommon to feel a bit 'down' after any
operation, so do ask your doctor or breast care nurse if
you feel you need more psychological support.
What are the benefits and risks of a Sentinel
Lymph Node Biopsy?
It is a safe method of biopsy. However as with any
procedure there are associated benefits and risks as
listed below:
Benefits:

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Minimal invasive and very accurate procedure
Smaller scar and there may be no need for a drain
Recovery is quicker
Less swelling in your arm and shoulder
(lymphoedema)
May experience less pain
Reduces risk of after effects of surgery:
o Seroma (accumulation of blood or fluid)
o Lymphoedema
o Numbness in the arm
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o Unnecessary removal of normal glands
or unaffected glands is avoided
Risks:
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Allergic reaction to the dye
Rash or redness and itchy skin due to dye
Some patients may look blue all over for a few
hours or the skin of the breast may be tinted
blue and this fades over few days to few months
depending on the individual patient.
Urine or bowel movement may be blue for 24 48 hours after surgery
It is not suitable for everyone
In 5% of cases disease can remain in the axilla
after removing a clear sentinel node
Sometimes sentinel node cannot be located
Health and Cancer Information Centre (Health Shop)
The Health Shop is a drop in Health and Cancer Information
Centre, based at the main entrance of the hospital. It
provides information and support on cancer and cancer
related issues.
Macmillan Cancer Information Manager:
Tel No: 0208 510 5191
Email: [email protected]
Website: www.homerton.nhs.uk
Homerton Hospital PALS (Patients Advice & Liaison
Service)
PALS is based in the main reception of the hospital.
Email: [email protected]
Tel: 020 8510 7315 (9am – 5pm)
PALS provides confidential information and support,
helping you to sort out any difficulties or concerns you
have whilst in hospital, guiding you through the different
services from the NHS.
Further Information:
Breast Cancer Care
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Provides information and support to those affected by
breast cancer - women and men, their partners, families &
friends. Produces a range of booklets and leaflets on
Breast Cancer.
Kiln House 210 New Kings Road, London SW6 4NZ
Helpline: 0808 800 6000 (10am- 5pm Monday to Friday &
10am-2pm Saturdays)
Email: [email protected]
Website: www.breastcancercare.org.uk
Breakthrough Breast cancer
Dedicated to saving lives by finding the causes of breast
cancer, improving detection, diagnosis, treatment and
services
Helpline No: 08080 100 200
Email: [email protected]
Website: http://www.breakthrough.org.uk
Macmillan Cancerline
Free information and emotional support for people living
with cancer.
Telephone translation service for those whose first
language is not English.
89 Albert Embankment
London, SE1 7UQ
National Helpline No: 0808 808 2020
Website: www.macmillan.org.uk
Related websites
http://www.nhs.uk/conditions/Cancer-of-the-breast-female
www .cancerhelp.org.uk
Information checklist:
You may find this checklist helpful when thinking about
the questions you want to ask your doctor. If there are
answers you don’t understand, ask your doctor to
explain again.
What type of breast cancer do I have?
What does false-negative rate mean?
1. What if the sentinel node biopsy is positive?
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2. Is the use of the sentinel-lymph-node biopsy common?
3. What happens if the sentinel node is negative and the
lymph nodes are positive?
4. What support can I get during my treatment?
If English is not your first language or you have
problems understanding this leaflet please let a member
of staff know.
Important information
Please remember that this leaflet is intended as general
information only. It is not definitive. We aim to make the
information as up to date and accurate as possible, but
please be warned that it is always subject to change.
Please, therefore, always check specific advice on the
procedure or any concerns you may have with your
doctor.
Hand Hygiene
In the interests of our patients the trust is committed to
maintaining a clean, safe environment.
Hand hygiene is a very important factor in controlling
infection. Alcohol gel is widely available throughout our
hospitals at the patient bedside for staff to use and also at
the entrance of each clinical area for visitors to clean their
hands before and after entering.
Other formats
If you require this leaflet in any other format please speak
to your clinical nurse specialist (Keyworker)
Reference
The following team members have been consulted and
agreed this patient information:
Consultant, Clinical Nurse Specialist (Keyworker),
Macmillan Cancer Information and Support Manager and
Patient
Produced by: Breast Team
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Reviewed: May 2014
Next date: May 2016
Homerton University Hospital NHS Foundation Trust
Homerton Row, London, E9 6SR
T 020 8510 5555
W www.homerton.nhs.uk
E [email protected]
Map: The London Independent Hospital
Address:
1 Beaumont Square, Stepney Green
London, E1 4NL
Telephone: 02077802400
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