![]() The lymphatic system is a system of lymph vessels and lymph glands throughout the body which play an important role in the body’s mechanism of fighting infections and tumours. (See Benefits of Specialisation ) Ask your surgeon how many SLNB cases he/she performs per month. Surgeons performing fewer than three SLN biopsies per month had an average success rate of 86.23% (failure rate 13.77%), surgeons performing three to six SLN biopsies per month had a success rate of 88.73% (failure rate 11.27%) and surgeons performing more than six SLN biopsies per month had a success rate of 97.81% (failure rate 2.19%) again underlining the advantages of specialisation, and being treated by a high caseload breast surgeon. (Cox et al, J Am Coll Surg, 2001) When viewed according to the surgical volume (cases per month) versus the success rate, three groups were identified. ![]() ![]() It has been shown that not only do increased overall volume of SLNB procedures lead to decreased failure rates, but also surgeons with high monthly averages of SLN biopsies have fewer failures than those with low monthly averages. ![]() It is very important that sentinel node biopsy is done by a surgeon who is trained and experienced in this technique. Sentinel node biopsy is a relatively new procedure, however most surgeons have adopted SLNB as a standard means of axillary nodal assessment. For women with clinically suspicious lymph glands or nodes that look abnormal on preoperative imaging, needle biopsy (often image guided) may provide a means to identify some patients who have positive involved nodes preoperatively, and who thus require axillary lymph node dissection rather than SLNB. There are still some situations when axillary clearance is needed, and if cancer cells are found in the sentinel node then axillary clearance is still often recommended. If the sentinel nodes are free of cancer, it is assumed that the remaining nodes are also clear and no further lymph nodes are then removed. Removing only the sentinel or ‘guardian’ nodes lessens the likelihood of complications and in most cases still provides the necessary information about the cancer. During a sentinel lymph node biopsy, the surgeon removes only a few (usually approx one to five ) sentinel lymph nodes, whereas in an axillary node dissection commonly around twenty nodes or more are removed. It aims to avoid some of the side effects of axillary dissection /clearance by removing fewer glands. SLNB is a minimally invasive and accurate alternative to axillary lymph node dissection (ALND) and is associated with reduced morbidity compared with axillary dissection. It is thought that if breast cancer cells were to escape into the lymphatic system, they would travel to the sentinel nodes before moving on to other nodes and the sentinel lymph node (SLN) technique is based upon the observation that tumour cells migrating from a primary tumour metastasise to one or a few lymph nodes before involving other lymph nodes. ![]() What is Sentinel Lymph Node Biopsy (SLNB)?Ī sentinel lymph node biopsy (SLNB) is a procedure in which the sentinel or ‘guardian’ lymph nodes are identified, removed, and pathologically examined to determine whether cancer cells are present. Usually, there is more than one sentinel lymph node. The sentinel node/s are the lymph nodes that the breast drains to first, and are the first lymph nodes to which cancer cells are most likely to spread from a primary breast tumour. Sentinel Lymph Node Biopsy for Patients With Early-Stage Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update (2017) What is a sentinel lymph node? Management of the Malignant Axilla in Early Breast Cancer-ABS Consensus Statement (2015) Axillary Surgery including Sentinel Node BiopsyĪxillary Surgery Following Neoadjuvant Chemotherapy- Multidisciplinary Guidance (2019)ĪSBrS Consensus Guideline on Axillary Management for Patients With In-Situ and Invasive Breast Cancer: A Concise Overview (2022) ![]()
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