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Sentinel Lymph Node Mapping Proven Effective in Predicting Spread of Breast Cancer

Surgeons at the University of Pennsylvania Cancer Center are using a technique that prevents pain and potential complications caused by routine lymph node removal in breast cancer patients. The procedure is called sentinel lymph node mapping.

In traditional mastectomies or lumpectomies, surgeons perform an axillary dissection -- removal of most or all of the lymph nodes -- from the woman's underarm because the lymph nodes are the most reliable predictor in determining if the cancer has spread to other areas of the body. Lymph nodes, which are small, bean-shaped glands, are usually found in clusters throughout the body. They help eliminate bacteria and viruses and are needed to drain and regulate the flow of lymphatic fluid. Without lymph nodes, lymphatic fluid builds-up and many women develop an uncomfortable chronic condition called lymphedema, which results in arm swelling and stiffness.

Sentinel lymph node mapping may eliminate this problem. The procedure involves injecting a radioactive tracer and a blue dye around the tumor site. These two substances travel from the tumor and drain into the sentinel, or main, lymph node. Together they give the surgeons a visible and audible marker as to the location of the sentinel lymph node. "In the past, we've had trouble identifying the sentinel lymph node and that's why we previously removed all the nodes," says Brian Czerniecki, M.D., assistant professor of surgery. "But this two-armed approach directly points us to the one or two main nodes that can predict whether cancer might be found in the rest of the lymph system."

A hand-held radioactive detector, similar to a Geiger counter, is scanned around the underarm area and a beeping sound pinpoints the location of the radioactive-filled node. After making a small incision, the surgeon can see the blue-dyed sentinel node. This node is then removed for pathological testing.

"If the node tests negative for cancer, we can accurately predict that the other nodes are also negative, thus sparing the patient excessive removal of the nodes," Czerniecki explains. "However, if the sentinel node tests positive, then it is necessary to remove the rest of the nodes."

In a preliminary study, Czerniecki and his colleagues performed the mapping procedure on 44 patients. In every case, the sentinel node mirrored the status of the other nodes. "This procedure has proven between 98-100 percent accurate in that the sentinel lymph node indicates the state of the surrounding nodes," says Czerniecki.

Sentinel lymph node mapping was first pioneered on melanoma patients and, after much success, surgeons applied the approach to patients with breast cancer. "By using this procedure, we cut costs by reducing the amount of pathology tests needed, but more importantly, we may eliminate major side effects of breast cancer surgery," he says.

Czerniecki is currently teaching other surgeons in the community how to perform this procedure. "Sentinel lymph node mapping will most likely become the standard of care for women undergoing breast cancer surgery, and we're in the process of teaching surgeons at area hospitals how to perform the technique."



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