Sentinel lymph node biopsy-SLNB

Although ALND is a safe operation and has low rates of most side effects, removing many lymph nodes increases the chance that the patient will have lymphedema after surgery (this is discussed below). To lower the risk of lymphedema, the doctors may use a sentinel lymph node biopsy (SLNB) procedure to check the lymph nodes for cancer. This procedure tells the doctor if cancer has spread to lymph nodes without removing as many of them first.

In this procedure the surgeon finds and removes the sentinel node (or nodes) — the first lymph node(s) into which a tumor drains, and the one(s) most likely to contain cancer cells if they have started to spread. To do this, the surgeon injects a radioactive substance and/or a blue dye into the area around the tumor, into the skin over the tumor, or into the tissues just under the areola (the colored area around the nipple). Lymphatic vessels will carry these substances into the sentinel node(s) over the next few hours. The doctor can use a special device to detect radioactivity in the nodes or can look for lymph nodes that have turned blue. (These are separate ways to find the sentinel node, but are often done together as a double check.) The doctor then makes an incision (cut) in the skin over the area in the armpit and removes the nodes. These nodes (often 2 or 3) are then looked at by the pathologist.

The lymph node can sometimes be checked for cancer during surgery. If cancer is found in the sentinel lymph node, the surgeon may go on to do a full ALND. If no cancer cells are seen in the lymph node at the time of the surgery, or if the sentinel node is not checked during surgery, the lymph node(s) will be examined more closely over the next several days. If cancer is found in the lymph node, the surgeon may recommend a full ALND at a later time.

Based on some recent studies in women, patients having breast-conserving surgery whose sentinel lymph nodes contain small amounts of cancer cells may be able to skip having a full ALND as long as they are going to have radiation. But because this hasn’t been studied well in patients who have had mastectomy, it isn’t clear that skipping the ALND would be safe for them. At this time, a full ALND is a standard part of the treatment for patients having a mastectomy who have a positive sentinel lymph node biopsy.

If there are no cancer cells in the sentinel node(s), it’s very unlikely that the cancer has spread to other lymph nodes, so no further lymph node surgery is needed. This lets you avoid some of the potential side effects of a full ALND.

A sentinel lymph node biopsy is not always appropriate. If an underarm lymph node looks large or abnormal by touch or by a test like ultrasound, it may be checked by fine needle aspiration. If cancer is found, a full ALND is recommended and a sentinel node biopsy is not needed.

Sentinel lymph node biopsy is a complex technique that requires a great deal of skill. It should only be done by a surgical team experienced with this technique. If you are thinking about having this type of biopsy, ask your health care team if this is something they do regularly.


Possible side effects of lymph node surgery


Chronic pain after breast surgery

Surgery Procedure for Male Breast Cancer


Radiation therapy for breast cancer in men

Chemotherapy for breast cancer in men

Hormone therapy for breast cancer in men

Targeted therapy for breast cancer in men

Bone-directed therapy for breast cancer in men



Coping and support for male breast cancer


Related Topics

Benign breast conditions

General breast cancer terms

Types of breast cancer in men








Oncologists, Breast Surgeons are the specialists who deal with the breast cancer