Sentinel node biopsy

General remarks

Intradermal injection has a better successrate compared to peritumoral injection

There is minimal benefit in identifying sentinel lymph nodes with addition of peritumoral blue dye to intradermal radioactive tracer injection. So, sentinel lymph node mapping and biopsy using intradermal-injected radioactive tracer can be used alone to effectively stage the axilla for breast cancer.

Step by step

1. Intradermal injection of radioactive 'tracer'
2. Perform radioactive scan to evaluate sentinel lymph node
3. Pre-operative intradermal injection of blue dye
4. Incision in lower axillary hairline
5. Opening investing fascia
6. Identify blue afferent lymphatic vessel
7. Trace blue lymphatic vessel and identify sentinel lymphe node
8. Remove sentinel lymph node
9. Check maximum radiation of lymph node
10. Measuring axillary background radioactivity (<10%)
11. Skin closure

References

Dermal Injection of Radioactive Colloid Is Superior to Peritumoral Injection for Breast Cancer Sentinel Lymph Node Biopsy: Results of a Multiinstitutional Study. Kelly M et al. Ann Surg. 2001 May; 233(5): 676–687 Intradermal radioisotope is superior to peritumoral blue dye or radioisotope in identifying breast cancer sentinel nodes. K.Lin, T.Patel, A.Ray, M.Ota, L.Jacobs, B.Kuvshinoff, M.Chung, M.Watson, D.Ota. J Am Col Surg. Volume 199, Issue 4, Pages 561-566