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Sentinel node biopsy

A usual part of breast cancer surgery is to remove the lymph nodes from the armpit (axilla) to see if there is any evidence that the cancer has spread from the breast to the lymph nodes and therefore, potentially, to other parts of the body. This information, along with other factors such as the size and grade of the tumour, helps the doctors determine the stage of the breast cancer and the most appropriate treatment.

One potential side effect of removing the lymph nodes from the armpit is a life-long risk of developing lymphoedema (swelling) in that arm. Alternative techniques, with fewer side-effects are of interest to researchers. One of these, sentinel node biopsy, has been the subject of recent national and international research.

Sentinel node biopsy is a surgical technique in which the first lymph node (or nodes) that cancer may spread to is removed. If the sentinel node does not have any cancer cells present, it is thought that the other nodes may also be clear of cancer. In this case removal of further nodes is not performed and consequently the risk of lymphoedema is significantly reduced and the recovery time is improved. If the sentinel node contains cancer, then the axillary lymph nodes are removed.

Many Australian women have participated in clinical trials such as the Royal Australasian College of Surgeons (RACS) Sentinel Node versus Axillary Clearance (SNAC) trial. Results from these trials suggest that sentinel node biopsy is safe for women with small, early breast cancers, although as yet there are no long term results from the research. The ability of this procedure to detect positive lymph nodes is very good. However, in some women, the sentinel node is clear, but cancer cells are actually present in other nodes.

  • Women should be fully informed, prior to choosing the type of surgery they wish to undergo, about the risks and benefits associated with all of the treatment options available to them.
  • It is important that women discuss the potential risks for them as an individual with their surgeon before making a decision to undergo any surgical technique.
  • If women choose to undergo sentinel node biopsy as a surgical procedure outside of a clinical trial, then they should satisfy themselves that their surgeon is competent to perform this surgical procedure. This means that the surgeon has complied with the position of the Breast Section of RACS regarding auditing their surgical cases against level 2 dissection using the SNAC trial protocol as a guide.
  • If women with large or multi-focal tumours choose to participate in clinical trials of sentinel node biopsy it is essential that they be provided with full information about any possible increase in their risk of developing a breast cancer recurrence that might result from them undergoing this procedure as an alternative to axillary clearance.