Sentinel Node Biopsy vs Axillary Lymph Node Dissection

Making Informed Treatment Decisions

Breast cancer affects millions of women globally, and early detection is vital for successful treatment outcomes. Sentinel Node Biopsy and Axillary Lymph Node Dissection play crucial roles in evaluating the spread of breast cancer to the lymph nodes.

Patients can actively engage in their treatment journey by understanding the concepts, procedures, advantages, limitations, and comparisons of these techniques.

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• Definition and Purpose

 Sentinel Node Biopsy is a minimally invasive procedure to determine whether breast cancer has spread to the lymph nodes. The sentinel lymph node(s), the first node(s) to receive drainage from the tumour site, is identified and removed for further analysis.

• Procedure

 During SNB, a small amount of radioactive tracer or blue dye or ICG (Indocyanin green) dye  is injected near the tumour. This tracer or dye helps identify the sentinel lymph node(s). The surgeon then performs a limited removal of these nodes and sends them for pathological examination.

• Advantages and Limitations 

SNB offers several advantages, including a lower risk of complications, minimal scarring, and faster recovery times than ALND. It is particularly suitable for early-stage breast cancer when the risk of lymph node involvement is low.

However, SNB may not be suitable for larger tumours involving the skin or more aggressive cancers with involved nodes, as it may not comprehensively evaluate the lymph nodes or may be futile.

• Definition and Purpose

 Axillary Lymph Node Dissection involves removing more lymph nodes from the armpit area to evaluate the extent of cancer spread. This procedure provides a more comprehensive nodal evaluation.

•  Procedure 

During ALND, the surgeon makes a larger incision in the armpit and removes multiple lymph nodes from the axillary region. This allows for a thorough examination of the lymph nodes and helps determine the stage of the breast cancer.

•  Advantages and Limitations

ALND allows for a comprehensive evaluation of lymph node involvement, providing vital information for determining the stage and appropriate treatment plan. However, it carries a higher risk of side effects such as lymphedema, which is swelling in the arm due to compromised lymphatic drainage. ALND also requires a more extended recovery period compared to SNB.

•  Indications and Decision-Making 

The choice between SNB and ALND depends on various factors, including tumour size, grade, and patient preferences. Current guidelines help doctors determine the most appropriate procedure for each case. SNB is generally recommended for early-stage breast cancer when lymph node involvement is less likely, while ALND may be performed when there is a higher risk of lymph node involvement.

• Recovery and Quality of Life 

SNB typically leads to faster recovery, less post-operative discomfort, and a lower risk of complications like lymphedema. ALND, on the other hand, may require a more extended recovery period and carries a higher risk of complications. Patients who undergo ALND may experience long-term effects on their arm function and quality of life due to lymphedema.

•  Recent Advances and Research 

Ongoing research and advancements in surgical techniques aim to refine the evaluation of the lymph nodes in breast cancer patients. Innovations, such as targeted molecular imaging and artificial intelligence, are being explored to enhance the accuracy of identifying sentinel nodes and reduce the need for more invasive procedures.

Recent studies have shown promising results in identifying specific genetic markers in breast cancer cells that can help determine the likelihood of lymph node involvement. This information can aid in selecting the appropriate surgical approach and minimising unnecessary procedures.

•  Shared Decision-Making 

The decision-making process in breast cancer treatment is collaborative between the patient and the oncologist. Patients must understand their diagnosis, treatment options, and associated risks and benefits. Engaging in open and honest discussions with an oncologist can help patients make informed decisions aligning with their values and goals.

• Patient Experience and Quality of Life

 Recovery time, impact on daily activities, and potential long-term side effects should be considered when making treatment decisions. While SNB offers faster recovery and fewer complications, ALND may be necessary in cases requiring a more extensive lymph node evaluation. Patients should discuss their preferences and concerns with an oncologist to ensure their treatment plan considers their quality of life.

• Recent Advances and Research 

Advancements in breast cancer research continue to shape treatment options and improve patient outcomes. Researchers are exploring innovative techniques such as molecular imaging, which uses specific markers to identify sentinel nodes accurately.

Artificial intelligence and machine learning algorithms are also being developed to enhance the accuracy of identifying lymph node involvement, reducing the need for invasive procedures.

Staying informed about these advancements can help patients make educated decisions and benefit from emerging technologies. In case if axillary clearance is required do discuss the option of LYmphovascular Microsurgical Healing Approach (LYMPHA).

During LYMPHA, the cut lymphatics draining the arm are directly anastomosed to a tributary of axillary vein. This procedure reduces the rate of significant arm lymphedema from 12 – 15% to as low as 2%. 

When making treatment decisions, patients must consider tumour characteristics, individual risks, and potential benefits. The goal is to provide personalised, patient-centred care that maximises treatment efficacy while minimising potential side effects. And of course do discuss the option of LYMPHA with your doctor.