Sentinel lymph Node Biopsy

Sentinel lymph node biopsy (SLNB) is a surgical procedure primarily used in managing breast cancer and melanoma. It assesses the risk of cancer spreading to the lymphatic system by examining the sentinel lymph nodes, the first nodes to receive drainage from a tumour.

Dr Jesse Hu
Dr Jesse Hu
Senior Consultant General Surgeon, Breast, Thyroid & Endocrine Surgery

When is Sentinel Lymph Node Biopsy Needed?

Sentinel lymph node biopsy is recommended for patients diagnosed with cancers that have a potential risk of spreading to the lymph nodes. The most common applications include:

  • Breast Cancer: SLNB is used when there is no evidence of lymph node involvement either through physical examination or imaging. It assists in determining whether further treatment, such as chemotherapy or radiotherapy, is necessary.
  • Melanoma: Advised for tumours thicker than 1 mm or those thinner but with high-risk features like ulceration, SLNB helps in accurate cancer staging and subsequent treatment planning.
  • Other Cancers: While less frequent, SLNB can be important for cancers like squamous cell carcinoma of the head and neck, aiding in precise staging and impacting treatment choices.

Benefits of Sentinel Lymph Node Biopsy

Sentinel Lymph Node Biopsy (SLNB) offers several key advantages:

Reduced Surgical Morbidity

SLNB involves removing fewer lymph nodes compared to traditional lymph node dissection, significantly lowering the risk of post-surgical complications such as lymphedema.

Accurate Staging

By examining the sentinel nodes, oncologists can more accurately determine the cancer’s stage, guiding further treatment decisions effectively.

Minimally Invasive

The procedure is less invasive than a full lymph node dissection, resulting in shorter recovery times and less discomfort for the patient.

Preparing for Sentinel Lymph Node Biopsy

Preparing for a sentinel lymph node biopsy involves several steps to ensure the safety and effectiveness of the procedure:

Patients typically undergo a thorough physical examination and review of their medical history. Imaging tests such as ultrasound or mammography may be used to evaluate the cancer and plan the biopsy approach.

Discuss all medications and supplements with the breast surgeon. Some may need to be discontinued, especially anti-inflammatory drugs like aspirin, ibuprofen, and naproxen due to their potential to increase bleeding risk.

Patients are usually required to fast for a specific period, generally eight hours before the procedure if general anaesthesia is to be used.

Since a dye is commonly used to identify sentinel lymph nodes, checking for potential allergies to these substances is important.

The Sentinel Lymph Node Biopsy Procedure

The procedure for sentinel lymph node biopsy typically involves the following steps:

Tracer Injection

A radioactive substance or dye is injected near the tumour site. This helps in identifying the sentinel lymph nodes as the first nodes that receive the lymph drainage from the cancerous area.

Mapping the Nodes

After the injection, a special camera or a handheld gamma probe is used to detect the radioactive tracer, mapping a path to the sentinel nodes.

Surgical Removal

The breast surgeon makes a small incision near the identified sentinel lymph nodes and surgically removes them. The number of nodes removed varies but is typically fewer than five.

Pathological Examination

The extracted nodes are examined microscopically for cancer cells. If no cancer cells are found in the sentinel nodes, this usually suggests a lower likelihood of metastatic cancer, potentially reducing the need for further aggressive treatments. The final treatment plan should be discussed with your breast surgeon, as decisions may depend on other diagnostic factors.

Immediate Analysis

In some cases, a rapid on-site evaluation called frozen section analysis may be performed to provide immediate results. This can influence further surgical decisions during the same procedure.

Postprocedure Care

After undergoing a sentinel lymph node biopsy, postprocedure care is important for recovery and monitoring. The following are key aspects of care:

  • Wound Care: Patients are advised on how to care for the incision site to prevent infection. This typically includes keeping the area clean and dry and watching for signs of infection such as redness, swelling, or unusual discharge.
  • Pain Management: Some pain or discomfort may be experienced at the incision site. Pain relief medications, often over-the-counter analgesics like acetaminophen or ibuprofen, may be recommended by the breast surgeon.
  • Activity Restrictions: To facilitate healing, patients may be advised to avoid strenuous activities or heavy lifting for a certain period, usually a few days to a week, depending on the extent of the biopsy and individual recovery rates.
  • Monitoring for Lymphedema: Especially in cases of breast cancer surgeries, patients should be vigilant for symptoms of lymphedema, such as swelling or feeling of heaviness in the arm or leg on the side of the biopsy. Early intervention can be beneficial in managing this condition.
  • Follow-Up Appointments: Regular follow-up appointments are necessary to monitor the healing process, review the pathology results, and discuss further treatment options based on the biopsy results.

Risks of Sentinel Lymph Node Biopsy

While Sentinel Lymph Node Biopsy (SLNB) is generally considered safe, it does carry certain risks:

There is a chance that SLNB might miss cancer cells in the lymph nodes, leading to under-treatment of the cancer.

Although less invasive, SLNB can still lead to complications such as infection, bleeding, or rare allergic reactions to the dyes used in tracing the sentinel lymph nodes.

Despite a lower risk compared to more extensive surgeries, there is still a possibility of developing lymphedema, a condition characterised by swelling due to lymph fluid accumulation.

Dr Jesse Hu

Dr Jesse Hu

Senior Consultant General Surgeon, Breast, Thyroid & Endocrine Surgery

Dr Jesse specialises in managing both benign and malignant breast and thyroid conditions, which also includes breast pain, breast lumps, breastfeeding problems, neck lumps, amongst others.

Her dual expertise in cancer removal and plastic surgery techniques expands the design of individualized treatments, leading to holistic patient outcomes.

Dr Jesse was part of the teaching faculties of both NUS Yong Loo Lin School of Medicine and Lee Kong Chian School of Medicine, where she teaches and mentors the next generation of medical students and trainee doctors.

  • Surgical training at NUS School of Medicine
  • FRCS (Fellow of the Royal College of Surgeons) Edinburgh, UK in 2014
  • Completed 2 Health Manpower Development Program (HMDP) fellowships at Oxford University Hospital, UK in 2016

Dr Jesse is recognized as an authority in breast cancer and thyroid surgery and a sought-after conference speaker.

Read Full Bio

Our clinics are under the following

insurance panels

For Singaporeans, Singapore Permanent Residents and Foreigners.
Please speak to our friendly clinic staff about using your insurance plans.

Reach Out To Us

We are committed to providing a one-stop experience, where you’ll receive a meticulous consultation and high-quality service in a comfortable environment.

Get Started

Book An Appointment





    image

    • Book An Appointment

    • Media Enquiry

    • Partnership Opportunity



    image

    For faster response, Call Us

    (65) 6733 3383



    Sentinel lymph Node Biopsy

    Frequently Asked
    Questions

    What Is the Accuracy of Sentinel Lymph Node Biopsy?

    Sentinel lymph node biopsy is highly accurate in detecting whether cancer has spread to lymph nodes. However, false negatives, where cancer is present but not detected in the sampled nodes, can occur. The accuracy depends on factors like the type of cancer and the technique used.

    How Long Does It Take to Recover from a Sentinel Lymph Node Biopsy?

    Patients typically resume normal activities within 1 to 3 days after a sentinel lymph node biopsy. Strenuous activities should be avoided for about two weeks. It is important to follow the breast surgeon’s instructions for wound care and to attend scheduled follow-up appointments.

    Will I Need Further Treatment After a Sentinel Lymph Node Biopsy?

    The need for further treatment depends on the biopsy results. If cancer cells are found in the sentinel nodes, additional treatments such as surgery, chemotherapy, or radiation may be recommended to manage the disease effectively.