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MANAGEMENT OF AXILLA Please choose an option from the menu below to see the information you require: Anatomy
of the lymph drainage of the breast
Sentinel node biopsy A more recent and potentially exciting development, which may avoid the need for a large number of negative axillary dissections, is sentinel node biopsy. It is now recognized that most breast cancers spread in a predictable path along the axillary lymphatics with the lowermost node in the chain (the sentinel node) being the first to be affected; the biological basis of this procedure is that examining the axillary nodes provides prognostic information about the risk of systemic recurrence. A negative sentinel node with skip lesions higher up the axilla occurs in only about 3% of cases. However, this procedure is not particularly therapeutic and carries considerable morbidity - hence the desire for a more selective local diagnostic procedure. The sentinel node
can be identified either by using an injection of a vital dye or, more
recently, by injecting a radioactive isotope bound to colloidal albumin,
with hand-held g-counter to guide the surgeon to the appropriate lymph
node. This procedure can be carried out before the definitive operation
or using frozen section at time of surgery. If the sentinel node is negative,
it is reasonable not to explore the axilla any further and if positive
proceeding to a formal axilla dissection; a large series justifying this
approach was recently reported by Veronesi et al. It is possible, if not
probable, that in coming years we will be able to gain equal or better
prognostic information from the primary tumour. If
you require further advice or information please contact the |
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