Patients with diagnosed breast cancer and melanoma receive an extensive work-up. This will include blood tests as well as radiographic imaging. If no metastatic disease is found, the physician must still determine the extent of disease. Sometimes this can be achieved with a physical exam. However, more often than not, this is not the case. Prior to an obvious metastasis, most cancers will first travel through the lymph system. Surgeons can determine the first lymph node likely to be affected using blue dye and a radioactive tracer placed around the area of cancer. The dye and tracer will be carried along lymph channels and collect in the first lymph node encountered. This lymph node is called the “sentinel lymph node” and is the first to harbor cancerous changes. This lymph node is visually localized with blue dye and the radioactive tracer. The surgeon will remove it and send it to pathology. If it is negative for cancer, the incision can be closed. If the lymph node is positive, patients usually require a lymphadenectomy or removal of a local basin of lymph nodes to prevent the spread of cancer.
The location of a sentinel lymph node depends on the location of the cancerous lesion. Breast masses usually have a sentinel lymph node within the axilla. Melanoma of the upper extremity also usually has a sentinel lymph node within the axilla. Melanoma of the lower extremity usually has a sentinel lymph node within the lymph nodes of the groin. Melanoma of the back or trunk can localize to either the axilla or groin lymph nodes. Lymphoscintigraphy, imaging of a particular lymphatic system, will help determine the likely lymph node basin affected prior to starting surgery.
Regardless of the site, the procedure is the same. The dye and radiotracer are injected around the cancerous mass. The area is massaged for several minutes to allow distribution of the dye and tracer. The tracer probe is used to localize the tracer within the lymph node basin. A small incision is made over the area of concern. With minimal dissection the blue dye is usually seen and lymph tissue localized and then excised. The excised lymph node is confirmed with the tracer probe. The process is repeated until no more lymph nodes are localized with the tracer probe and no blue lymph nodes are appreciated within the incision. The area is then closed. This process avoids the morbidity of a lymphadenectomy for those patients without metastatic disease. Most patients tolerate the procedure well and are discharged home the same day. Most resume normal activities the day after surgery.
A sentinel lymph node biopsy is a challenging procedure that deserves the attention of a board-certified surgeon. Dr. Jenna Kazil is a spectacular double board-certified vascular and general surgeon in the city of Bradenton, Manatee County who has passed a challenging set of exams to earn this certification. Dr. Kazil is a top vascular surgical specialist that sees patients from Desoto Hardee, and Sarasota counties at the Florida Surgical Clinic. She operates with the highest expertise possible at various hospitals and a surgery center. When patients are seeking the services of a remarkable Bradenton vascular surgeon for a sentinel lymph node biopsy, they should contact this clinic to schedule a consultation.