Dr. Brent Nykamp, General Surgeon at Orange City Area Health System, Northwest Surgery, performs sentinel lymph node biopsies with lumpectomy or mastectomy. This procedure is part of our comprehensive Breast Health service offering, giving you the best diagnoses tools and treatment options for breast cancer in our compassionate, total healing environment. Learn more …

FACT: Breast cancer is the most common cancer among American women, except for skin cancers. The chance of developing breast cancer at some time in a woman’s life is about 1 in 8 (12%). In 2009, an estimated 192,370 new cases of invasive breast cancer will be diagnosed among women in the United States. In addition to invasive breast

cancer, there will be about 62,280 new cases of carcinoma in situ (CIS) in 2009. CIS is non-invasive and is the earliest form of breast cancer. Until recently, when a woman with a malignant breast tumor had surgery for removal of the tumor, the surgeon performed an axillary lumph node dissection.

“Two things are necessary for surgical treatment of breast cancer,” explains Dr. Nykamp. “Remove the tumor in the breast, and also evaluate the lymph nodes in the axilla (armpit) to determine if the cancer has spread – or is metastatic.” During an axillary lymph node dissection, the surgeon makes an incision underneath the patient’s arm and removes the bulk of the lymph tissue that drains from the breast. That tissue is then sent to a laboratory to see if any of the nodes contain cancer. “When we remove the majority of the lymph nodes – about 15 to 20 – it’s quite a large surgery, requires insertion of a drain, and involves risk for fluid collection and arm swelling,” says Nykamp. “There is also a longer recovery time.”

Now Orange City Area Health System offers an alternative: sentinel lymph node (SLN) biopsy.

According to Nykamp, the sentinel node is the first node in the chain of drainage from the breast, and therefore if cancer has spread from the primary tumor, it is the first node to be positive for cancer cells. In an SLN biopsy, only the sentinel node is removed and evaluated. “This procedure requires just a small incision and the removal of a pea-sized mass of tissue – with a very short recovery,” says Nykamp. In fact, SLN biopsy means that the patient need not stay overnight in the hospital (unless a mastectomy is performed rather than a lumpectomy), there is no need for a drain, and the patient is typically doing regular activities within a few days.

So, how is a sentinel node biopsy done?

“Our radiologist injects a radioactive dye near the tumor just prior to surgery,” Nykamp explains. “Then in the OR we use a handheld geiger counter to identify the first node that the dye traveled to – the sentinel node. Based on the reading, we remove one or more nodes. After the pathology comes back from the lab, we know if the cancer has indeed spread to the sentinel node or if it is contained to the breast – in other words, non-metastatic.” If the SLN does have cancer cells in it, an axillary node dissection is performed.

According to cancernews.com, a negative sentinel node indicates a >95% chance that the remaining lymph nodes in the axilla are also cancer free. Since about 70% of U.S. breast cancer cases are contained to the breast, sentinel lymph node biopsy spares that many women from the risks of a full axillary lymph node dissection.

If you have any questions about this procedure or our other breast health services, please talk to your doctor.