Lymph nodes are part of the lymphatic system and play an important role of defense against infection. Lymph nodes drain excess tissue fluid through tiny lymphatic vessels before emptying into the main part of the blood stream. Cancer cells from the breast can pass along these lymph vessels and get trapped at the filters (nodes) in the axilla.
When these lymph nodes are involved, they enlarge over time to become palpable and can also be seen by ultrasound examination. Small samples of cells can be obtained by needle aspiration for examination under a microscope by an expert pathologist to confirm or exclude lymph node involvement.
When breast cancer is confirmed to have spread to the lymph nodes in the armpit they are removed as a whole group (Axillary Lymph Node Dissection) by incision under the armpit. This operation is sometimes shortened to the name Axillary Dissection.
After axillary dissection surgery a temporary drainage tube is placed under the skin and left in position to drain excess lymphatic fluid that often leaks from the around the area. This is then removed 3-5 days later once the fluid has stopped accumulating. Rarely the fluid (seroma) may continue to re-accumulate under the skin and may require 1 or 2 further aspirations in Dr Girardi’s consulting rooms before resolving.
Sentinel lymph node biopsy is a new technique where, instead of removing the entire block of nodes in an area of the body (e.g. armpit or axilla) only 1 or 2 nodes are removed to check for the presence of cancer cells that may have already spread. This expert technique performed by Dr Girardi for his patients prevents complications associated with entire axillary block dissection. This procedure is usually done at the same time as the breast cancer surgery in the one operation.
The patient will need attend a nuclear medicine facility on either the same day as the date of the operation with Dr Girardi or the day prior, to have a radioactive tracer substance injected into the areolar area of the breast involved with cancer. The patient then presents to the hospital for surgery at which time during your the operation while under anaesthesia, Dr Girardi will inject a blue dye near the tumor. Both the radioactive tracer substance and blue dye are used to locate the position of the sentinel lymph node using a device that detects radioactivity and the lyph node is then removed through a small incision (about 2cm) in the overlying skin of the armpit (axilla). The lymph node that is radioactive and stained with the blue dye is removed.
The sentinel node is then sent away to be checked for the presence of cancer cells by a pathologist. This usually takes 5 days for the pathologist to determine if there is cancer cells present in the lymph node. If cancer is found, additional lymph nodes may need to be removed. These nodes will be reomved as part of a Axillary Dissection. This procedure will require a subsequent admission to hospital and will require a short stay in the hospital.