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Sentinel Node Biopsy

Implementation

Preoperative

  • 99m Tc-labelled colloidal human albumin is injected peritumorally at the department of nuclear medicine.
  • While images are taken, the patient lies on her back with the arm over her head.
  • The first images are taken immediately after the injection.
  • New images are taken after 30 minutes.
  • As needed, images are taken after 4 hours.
  • The position of the sentinel lymph node is marked on the skin, from the front and side.

Preoperative

A gamma detector is used during the operation, which registers the radioactivity.  Methylene blue is used simultaneously to increase the detection rate of the sentinel lymph node.

  • Methylene blue is injected peritumorally at the beginning of the operation.
  • An incision is made in the skin according to preoperative drawing.
  • The sentinel lymph node is identified with the aid of the gamma detector.
  • The sentinel lymph node is removed.
  • The lymph node is verified with the gamma detector, and if there are several, they are also removed.
  • The lymph node is sent for histological examination.

With a negative frozen section, an axillary dissection in not performed. Immunohistochemical tests are then awaited from the pathologist, which usually take about one week.    

If there is evidence of cancer cells, an axillary dissection is performed. This occurs in 5% of cases.

In the event the surgeon does not find the sentinel lymph node, an axillary dissection must be performed.

The procedure is followed by breast conservative treatment or mastectomy.

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