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Sentinel Node Biopsy

Last updated April 19, 2019

Approved by: Maulik P. Purohit MD MPH

DoveMed.com

Microscopic pathology image of lymph node showing metastatic carcinoma.


Background Information:

What are the other Names for the Procedure?

  • Lymph Node Sentinel Biopsy
  • Lymph Node Sentinel Excision
  • Sentinel Node Excision

What is Sentinel Node Biopsy surgical procedure?

  • Sentinel lymph node(s) is defined as a lymph node, or a group of lymph nodes, to which a cancer spreads. The cancer may be a carcinoma, melanoma, or sarcoma
  • Sentinel Node Biopsy is a diagnostic procedure that involves the removal of one or more small lymph nodes that are then tested to check, if cancerous cells have spread (metastasized) to the node
  • This surgical procedure is usually performed when assessing breast cancer or melanoma

What part of the Body does the Procedure involve?

Sentinel Node Biopsy involves the axillary lymph nodes and sometimes the groin, chest, or abdominal lymph nodes.

Why is the Sentinel Node Biopsy surgical procedure Performed?

Sentinel Node Biopsy may be performed in a variety of scenarios:

  • At the time of tumor removal
  • If the sentinel lymph node is positive, the surgeon may choose to remove more lymph nodes for staging
  • Sometimes, a Sentinel Node Biopsy is performed after the tumor is removed, to perform tumor staging for breast cancer or melanoma
  • It can be performed for other cancer types also

What are some Alternative Choices for the Procedure?

Sentinel Node Biopsy remains the gold standard technique for assessing, if the cancer has spread to the nearby lymph nodes. Sometimes, the surgeon may remove the entire group of lymph nodes that drain the tumor site.

What are the Recent Advances in the Procedure?

Recent advances have occurred in the field of radioactive dye and detection. These procedures help evaluate the sentinel lymph node more accurately.

What is the Cost of performing the Sentinel Node Biopsy surgical procedure?

The cost of Sentinel Node Biopsy procedure depends on a variety of factors, such as the type of health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused by the information regarding Sentinel Needle Biopsy and on what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
  • Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

Prior to Sentinel Node Biopsy surgical procedure:

How is the Sentinel Node Biopsy surgical procedure Performed?

The Sentinel Node Biopsy surgical procedure is performed in the following manner:

  • During a Sentinel Node Biopsy, radioactive substance or a blue dye, or sometimes both are injected at the site of the tumor
  • After a short period of time, the radioactive substance or blue dye reaches the nearest lymph node (or lymph nodes), through the lymphatic vessels
  • Using a special device that detects radioactivity, the lymph node (lymph nodes) is located
  • A small incision is made on the skin over the identified lymph node. The lymph node(s) is removed and sent to a pathologist for analysis in the laboratory
  • The incision is closed with a suture on the skin
  • The pathologist identities if cancer cells are present in the lymph node(s)

Where is the Procedure Performed?

The procedure is usually performed in an out-patient surgery center facility or a hospital.

Who Performs the Procedure?

A surgeon performs the Sentinel Node Biopsy procedure.

How long will the Procedure take?

The surgical procedure usually takes about 1 to 2 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Sentinel Node Biopsy procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

The following preparations may be performed prior to a Sentinel Needle Biopsy procedure:

  • The physician may evaluate the individual’s medical history to gain information related to the overall health status including the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the individual from undergoing the procedure
  • Normally local anesthesia is not used; however, do inform the physician if you are allergic to any local anesthetics, lidocaine, etc
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for the Sentinel Needle Biopsy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Sentinel Node Biopsy surgical procedure?

Before a Sentinel Node Biopsy procedure, the patient should undergo certain tests such as:

  • Electrocardiogram (EKG) in elderly individuals having a history of heart disease
  • Other tests may be prescribed based on the physician’s evaluation

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Sentinel Node Biopsy?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • What are the complications that might take place during recovery?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • What are the costs involved?

During the Sentinel Node Biopsy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia is administered for the procedure.

How much Blood will you lose, during the Procedure?

There is typically little to no blood loss involved during a Sentinel Node Biopsy surgical procedure.

What are the possible Risks and Complications during the Sentinel Node Biopsy surgical procedure?

There are general factors that increase the risk of getting complications during a Sentinel Node Biopsy surgical procedure and they include:

  • Obesity: Generally greater the degree of obesity, greater is the surgical risk
  • Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness, such as autoimmune disorders, chronic infections
  • Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgery include:

  • Infection within the surgical wound
  • Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Sentinel Node Biopsy surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.

After the Sentinel Node Biopsy surgical procedure:

What are the possible Risks and Complications after the Sentinel Node Biopsy surgical procedure?

The possible risks and complications that may arise after a Sentinel Node Biopsy are:

  • Abnormal and prolonged fluid drainage from the surgical wound
  • Infection within the surgical wound
  • Numbness around the surgical wound
  • Damage to the nerves
  • Excessive swelling due to lymphedema

What is the Prognosis after the Surgery?

  • The prognosis is usually good following a Sentinel Node Biopsy. Most patients achieve a full recovery from the procedure
  • Generally, a complete recovery takes about 3-4 weeks

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Bleeding or fluid drainage from the surgical wound
  • Pain, numbness, abnormal swelling, or cold sensation within the arm
  • Signs of an infection
  • Fever
  • Dizziness
  • Feeling sick
  • Muscle aches and headaches
  • Complications associated with prescription medications used in the treatment

What Post-Operative Care is needed at Home after the Sentinel Node Biopsy surgical procedure?

At home, the following post-operative care is recommended, after a Sentinel Node Biopsy procedure:

  • Slowly resume regular/daily activities as early as possible, which aids in a faster recovery
  • Use a heat pad or warm compress to relieve pain due to the incision
  • Resume showering and keep the wound clean and dry. Gently wash the surgical wound with mild soap. Replace the dressings after showering
  • Complete the course of prescribed medication as advised by the physician
  • Individuals may take acetaminophen to relieve pain. However, do not take prescription pain-killers longer than prescribed
  • Avoid sex till a complete healing has taken place (under advice by the physician)

How long does it normally take to fully recover, from the Procedure?

It takes about 2 to 3 weeks to fully recover from the Sentinel Node Biopsy surgical procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision
  • Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Sentinel Node Biopsy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The outpatient facility or a hospital
  • An anesthesiologist
  • A pathologist
  • A surgeon

The patient is advised to inquire and confirm the type of billing, before the Sentinel Node Biopsy procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: July 10, 2017
Last updated: April 19, 2019