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The sentinel lymph node, also called the guard node, is the lymph node in the arm pit where breast cancer will first spread. The surgeon uses either a special blue dye or radioactive isotope (or in some cases both) which is injected into the breast prior to surgery.
The dye or isotope used then moves from the tumor to the lymphatic system. The first node to turn blue or contain the radioactive material is referred to as the sentinel node. The first node that turns blue (using the dye method) or that is hot with the Geiger Counter (using the radioactive isotope) is removed and immediately examined by the pathologist
A sentinel node biopsy determines if breast cancer has spread to the lymph nodes. An important part of staging cancer, it impacts recommendations for a patient's treatment. At Johns Hopkins, the sentinel node biopsy is the standard of care for determining the presence of cancer in the axillary lymph nodes.
The sentinel lymph node(s) will be sent to pathology for analysis and staging of the breast cancer. The pathology report will then be shared with you at your one week post operative appointment. If the sentinel lymph node is negative for tumor cells, the remaining lymph nodes are left intact This reduces the risk of lymphedema in the future, as well as preserves healthy tissue that doesn’t need to be surgically disturbed. However, if the node is positive, a more comprehensive decision will be made whether other nearby nodes need to be removed and examined for cancer in a future surgery.
At the Johns Hopkins Breast Center, our surgeons have been performing sentinel node biopsies since 1996, when they began as clinical trials. Because of our work—and that of colleagues at other centers—sentinel node biopsy is now the standard of care for determining the presence of cancer in the axillary lymph nodes.
Knowing if the cancer has spread to the nearby lymph nodes is a critical part of staging, and therefore impacts the recommendations for treatment of the patient’s breast cancer.