Lymph Gland Surgery
If the lymph glands are shown to be involved then we will advise that all the glands associated with the breast are removed at the time of your initial surgery (axillary clearance).
However, if we are able to confirm that none of the lymph glands show any sign of cancer spread, then it is unnecessary to remove them all. The most reliable way of confirming that the glands are clear is to remove the nearest glands to the cancer for analysis. This is called “sentinel node biopsy”.
Sentinel node biopsy involves putting a tiny amount of isotope tracer into the nipple area which then gets picked up in the lymph ducts and transferred to the nearest lymph gland in the under arm area where it collects. This collection can be found with a sensitive radiation detector which directs the surgeon which gland to remove. Sometimes there is more than one gland identified, in which case more than one gland may need to be removed. On average 2 glands need to be taken out of the 25 or so that can be found under the arm. Occasionally the isotope does not travel to the glands, so it is usual to use a blue dye put in to the nipple area at the beginning of the operation which works similarly to the isotope. The blue dye often stains the skin for a few days and, since it is passed out with the urine, often makes the urine a greeny-blue colour for 24 hours.
We are one of only a few breast units in the UK able to analyse the sentinel node(s) during the operation using the metasin PCR method. Otherwise the gland will need to be examined under the microscope which takes about 5 working days. This means that a second operation is required if the glands show cancer within them, whereas with the metasin method the clearance of the remaining nodes can be done immediately.