Sentinel node examination

Introduction
This folder will provide you with information about the sentinel node examination and how this is carried out in the Department of Nuclear Medicine at the Bronovo Hospital. Your surgeon has already discussed this with you. In this folder, you will find detailed information concerning this examination.  

What is a sentinel node?
The sentinel node, which is generally in the armpit, is the first lymph node that the lymph ducts from the breast drain into. This is called the "sentinel node" because it forms the entrance to the other lymph nodes. The sentinel node can provide information on the possible presence of metastases in this or other lymph nodes in the armpit.

Objective of the examination
The objective is to locate and map out this first lymph node, to which the tumor could possibly metastasize, as preparation for the surgery. The examination is also intended to enable us to make good decisions concerning the course of the treatment.

Until recently, all of the lymph nodes in the armpit were removed in all patients with breast cancer; the so-called "axillary clearance." Removal of all of the lymph nodes can have unpleasant side effects for the patient, such as: pain in the armpit, swelling of the arm and difficulty of movement. By first removing only the sentinel node and examining it for tumor cells, the procedure can, in the absence of metastases in this node, be restricted.  

Preparation
There is no specific preparation necessary for this examination.

The examination
The examination consists of localising the sentinel node and bringing it into view by means of a lymph node scintigram. This examination takes place in the Department of Nuclear Medicine on the day prior to the operation and the scan is repeated as a check immediately before the surgery.

In order to make the sentinel node clearly visible, a mildly radioactive fluid is injected, which is made visible with the aid of a special camera.

During the examination, you lie on your back on an examination table. Using a thin needle, the nuclear physician injects a small amount of radioactive fluid at the location of the tumor. The jab with the needle through the skin may be a bit painful, comparable to a jab when blood is taken for a test.

After the fluid is injected, a camera is placed right above you. With the aid of this camera, the radioactive lymph node is made visible. Several images will be recorded. This takes about 45 minutes. After 2 - 3 hours this procedure will be repeated.
Subsequently, the position of the lymph node is marked on the skin with a felt-tipped pen in order to make the surgery location clear.

It is essential that you lie as still as possible so that the pictures will be sharply focused. It is possible to bring along an iPod so that you can listen to music during the examination. 
On the day of the surgery, another scintigram will be done. This scintigram shows  how the injected material has moved from the breast to the lymph nodes. The nuclear physician will discuss these results with your consulting surgeon.

Supplementary information
You will only be given an extremely small amount of radioactive fluid. The amount of this substance has no side-effects and is not dangerous for you and the people around you.

In conclusion 
If after reading this folder, you still have questions, you may contact: The Department of Nuclear Medicine via telephone number 070 - 312 40 70.

More information on nuclear medicine can be found in our Bronovo folder ‘Nuclear Medicine'.

If you have access to internet, you can find information on nuclear medicine at  the medical department Nuclear Medicine.                

Edition: April 2009/470