Removal of sentinel lymph node(s)

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1 Removal of sentinel lymph node(s) Exceptional healthcare, personally delivered

2 What is a sentinel lymph node? The sentinel lymph nodes (glands) are the first lymph nodes in your armpit to which breast cancer can spread. Usually there are two or three sentinel nodes, but occasionally there may be more. What is sentinel lymph node biopsy (SLNB)? By removing the sentinel lymph node, we can find out whether the breast cancer has or has not spread to the armpit nodes. This important information helps us to advise you about the stage of your cancer and the best type of breast cancer treatment for you. Side effects of armpit surgery For some patients armpit node removal can cause temporary shoulder stiffness, pain, and/or permanent lymphoedema (swelling of the arm). The side effects of armpit surgery generally increase with the number of nodes removed. This means if we remove only the sentinel nodes, side effects are likely to be less than traditional armpit surgery where more nodes are removed. Finding the sentinel node Before surgery a small amount of radioactive fluid will be injected into your breast, using a very fine needle to minimise any discomfort. The dose of radiation is very small (equivalent to approximately two mammograms). This fluid travels to the sentinel node. You may have a scan to identify the number and position of the sentinel nodes prior to surgery. 2 Removal of sentinel lymph node(s)

3 Because the radioactive fluid does not always travel to the armpit nodes, during surgery a blue dye will be injected into the breast also. This travels to the sentinel nodes. Using a special detection probe the surgeon can then find the radioactive sentinel nodes, and also identify nodes stained blue by the dye. This Dual dye technique increases the chances of finding the sentinel nodes to almost 100%. Before your operation You will need to sign a consent form: To have sentinel lymph node biopsy using radioactive fluid and blue dye. If the surgeon cannot find the sentinel node we need your permission to remove a larger sample of approximately four nodes, but this will be discussed with you when you sign your consent form. During your operation Once the sentinel lymph node has been removed this is then cut and processed using One Step Nucleic acid Amplifi cation (OSNA). This test takes about 30 minutes, and will tell your surgeon whether any cancer has been detected in the sentinel lymph node. If the test is negative, you will not require any more lymph nodes to be removed. If the test is positive, the surgeon will then go on to do a level two axillary node clearance which involves removing more lymph nodes from your arm pit, up to the border of one of your chest wall muscles. This is because if one sentinel node is positive, there is a 50% chance that another non-sentinel lymph node will be positive. Removal of sentinel lymph node(s) 3

4 What are the benefits of sentinel lymph node biopsy? The main benefit of SLNB is that potentially unnecessary surgery can be avoided if the SLN is negative, which means: Less discomfort and earlier mobility in the shoulder/arm. Less risk of lymphoedema. No drains. Possible shorter hospital stay and quicker overall recovery. Targeted lymph node excision. If the sentinel lymph node is positive: Further lymph nodes can be removed during this operation avoiding the need for a second arm pit operation and also means that your final results will be available sooner. What are the disadvantages of sentinel lymph node biopsy? Stinging sensation and discomfort when the radioactive fluid is injected into the breast. Blue dye will discolour urine, stools, contact lenses (please remove before surgery), tears etc for a few days. The breast skin will be discoloured for up to a few months and very occasionally a year or so. Allergic reaction to the blue dye may occur in 0.4% of patients. Should this happen it is rarely severe and can be treated. 4 Removal of sentinel lymph node(s)

5 How accurate is the OSNA test? Studies have shown that one step nucleic amplification is a highly sensitive and specific tool for analysing lymph nodes at the time of operation, proving to be more than 96% accurate. Further information If you would like to talk to someone for further information about this or any aspect of your treatment, please contact your breast care nurse. NHS Constitution. Information on your rights and responsibilities. Available at Removal of sentinel lymph node(s) 5

6 Notes/Queries 6 Removal of sentinel lymph node(s)

7 Notes/Queries Removal of sentinel lymph node(s) 7

8 How to contact us: General enquiries If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice. North Bristol NHS Trust. This edition published June Review due June NBT002739

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