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Sentinel Node

The pain and swelling accompanying melanoma and breast lymphadenectomies are becoming a thing of the past at Ellis Fischel Cancer Center thanks to a procedure called the sentinel node biopsy. Described as an exciting breakthrough in surgery, the technique promises pain reduction and highly accurate diagnoses.

Ellis Fischel Cancer Center is currently the only hospital in mid-Missouri using the technique, and is participating in a multicenter sentinel node clinical trial run from the American College of Surgeons Oncology Group. The sentinel node is receiving much-deserved attention today. As the name "sentinel" indicates, the node stands guard and acts as a messenger.

The message in this case is malignancy or nonmalignancy and is delivered in the following manner: The patient is injected with a blue dye, a radioactive substance or a combination of both. The sentinel node then absorbs the dye/radioactive substance. Next, a radiation probe, similar to a Geiger counter, is used to find the substance and thus the sentinel node. Alternatively, if the dye is used alone, the surgeon can lift a flap of skin and look for the trail of blue dye. The lymph nodes turn blue and can be identified by color and the presence of radioactivity.

Upon finding the node, the 98 percent accuracy rate in diagnosing the presence or absence of cancer is partially because the pathologist is not bogged down with biopsies of multiple nodes. Whereas the average lymph node dissection involves slicing the node into about two or three pieces, sentinel node biopsies involve a more comprehensive evaluation.

Applying the sentinel node biopsy to breast cancer patients evolved naturally from the research on melanoma patients. Patients found to be node negative did not need further lymph node dissection. As a result, they did not experience the lymphedema sometimes involved in full node removal. Breast cancer patients became the logical next step.

The under-arm incision is the most painful aspect of such lymphadenectomies. If a sentinel node biopsy is done through a small incision, information regarding the presence or absence of lymph nodes may be obtained without removing many of the lymph nodes.