Ein Brustkrebs und sein Verlauf


My Breast Cancer and its History


Breast Cancer: Surgery


standard in Switzerland

since 2004:

What is a Sentinel Lymphnode Biopsy?

At first the question will probably emerge: "What actually means SENTINEL?". Sentinel is a guard. A sentinel lymphnode is the first lymphnode in the lymphatic system of a mamma carcinoma, i.e. of a breast. It has the largest probability of a metastatic infestation, should such be present.

With the surgery of a breast cancer, it was so far usual to remove the axilla lymphnodes for security. However it appeared that in the majority of women operated in such a way, the lymphnodes were not at all attacked, so it would not have been necessary to remove so many, and to accept the side effects (like movement restriction, lymph edema).


In order to be able to limit these side effects, the sentinel lymphnode biopsy was developed, sometimes abbreviated as SLNB. The AGO-study was accomplished at the end of 2003. This means that from now on this technology should be applied, if ever possible.


Whether a sentinel lymphnode biopsy shall be made, must be already clarified before a surgery. The size of the tumor plays a role. And the axilla lymphnodes may not yet look attacked by metastases in the palpation findings and during the ultrasonic investigation (including a tissue sample in case of an enlarged lymphnode).


During the preparations for the sentinel lymphnode biopsy the day before the operation, the area of the tumor is marked with an injected radioactive substance. The lymphscintigram indicates the position of the sentinel-(= guard) lymphnodes.

At the beginning of the surgery, a blue colour is additionally injected , which tints the lymphnodes after massaging the breast. By gamma detector, the radioactive/hot and blue lymphnodes can be found and removed by a small cut (often in the armpit).


When a sentinel lymphnode biopsy has been made (even after one has come to the conclusion that the lymphnodes should be ok), a frozen section, taken during the surgery, must show whether these particular sentinel lymphnodes (several are possible) are really free of metastases.

If, nevertheless, the result shows that the sentinel lymphnodes are attacked, then further lymphnodes should be surgically removed, as has been usual up to now.

Even if the examination of the frozen section reveals that no lymphnodes are attacked, the sample will be later examined again in detail by microscope, so that each micrometastase can be found. The result of this examination is obtainable unfortunately only about one week after the surgery. With bad findings, the axilla lymphnodes should subsequently be removed.


The advantages of a sentinel lymphnode biopsy are important. Nowadays a SLNB should actually always be considered in place of a hitherto usual axilla lymphnode removal. However, this requires a hospital with a nuclear department and physicians having sufficient experience with the method.

It is thus very important to select a clinic which can carry out the sentinel method: whether it owns a nuclear department itself, or then has the possibility of co-operating with a close-lying hospital with such a department.


In this homepage (see "Ärzteinformation" in the German version) a lecture is inserted about


"Standards of the Sentinel Lymph Node Biopsy"

by PD Dr. med. Mathias K. Fehr


The lecture was intended for physicians at a yearly congress and is not quite simple for us laywomen to understand. The pictures point out the fact that a combined method with radioactive tracer (injected at the seat of the tumor the day before the surgery) and blue colour (during the surgery rubbed into the breast tissue) excludes more likely errors when tracing the first lymphnodes. One of these methods alone is too inaccurate, wrong lymphnodes could be taken out, and the first one with the liquid from the tumor could still be inside and perhaps contain metastases.


I hope that my explanations of this method are understandable and that I can contribute to clear uncertainties.

In "Surgery" there are also surgery reports inserted with the description of my sentinel lymphnode biopsies on both sides: on the left side, five marked sentinel lymphnodes were removed, also five lymphnodes of Level I being in between; on the right side three sentinel lymphnodes were removed and also one of Level I, all without proof of a carcinoma. - Complications: one week after the surgery a large seroma in the left armpit/axilla, see , and a light smaller seroma in the right armpit had appeared.


Since I had the surgery of my breast cancer in January 2004, some years have passed - up to now without any lymph edema.

I am thus very grateful that in my case the SLNB could be carried out.



© Erika Rusterholz