THE STATUS OF the lymph nodes is the most important diagnostic indicator in breast cancer, previously determined through axillary lymph node dissection (ALND). In the mid-1990s, sentinel lymph node biopsy (SLNB) emerged as an accurate, less invasive alternative to ALND. With its shorter OR time, decreased risk of lymphedema and impaired range of motion, and lower prevalence and severity of post-op neuropathic sensations, SLNB is now considered a standard of care for the treatment of early-stage breast cancer (see Comparison of SLNB and ALND).
Let's take a closer look at SLNB and what you need to do for your patient who's undergoing the procedure.
Sentinel on duty
The sentinel lymph node is the first node (or nodes) in the lymphatic basin that receives drainage from a primary tumor in the breast (see Lymph nodes of the breast and axillary region). It's identified by injecting a radioisotope and/or blue dye into the breast, which travels via the lymphatic pathways to the node. In SLNB, the surgeon uses a handheld probe to locate the sentinel node, excises it, and sends it for pathologic analysis, which is often performed immediately during the surgery using frozen section analysis. If the sentinel node is positive, the surgeon can proceed with an immediate ALND, sparing the patient a return trip to the OR and additional anesthesia. (The patient may also opt to return for additional surgery at a later time.) If the sentinel node is negative, ALND isn't needed.
After the SLNB procedure is complete, all the collected specimens are sent to pathology for more thorough analysis. Patients who undergo SLNB in conjunction with breast conservation are generally discharged the same day. Patients who undergo SLNB with total mastectomy usually stay in the hospital overnight and possibly longer if breast reconstruction is being performed.
Before and after SLNB
If your patient is scheduled for SLNB:
* Inform her that although frozen section analysis is highly accurate, false-negative results can occur. A negative sentinel lymph node on frozen section analysis may show metastatic disease on subsequent analysis, indicating that ALND is still necessary.
* Reassure her that the radioisotope and blue dye are generally safe.
After the procedure:
* Tell her that she may notice a blue-green discoloration in her urine or stool for the first 24 hours as the blue dye is excreted.
* Although the incidence of lymphedema, decreased arm mobility, and seroma formation (collection of serous fluid in the axilla) is generally low, prepare her for the possibility of these complications.
* Inform her that although post-op neuropathic sensations may occur, they're often less severe in patients who underwent SLNB than those who had the ALND procedure.
Your support is requested
Although SLNB is a less invasive procedure than ALND and results in a shorter recovery period, your patient undergoing SLNB also has many difficult issues to deal with surrounding her breast cancer diagnosis and treatment. Remember to listen, provide emotional support, and refer her to appropriate specialists when indicated. With your help, she'll have a better understanding of the procedure and her diagnosis.
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