Recently, Gordon Schwartz, MD, Professor of Surgery, Jefferson Medical College, started using a new procedure called sentinel node biopsy on all his patients undergoing breast conservation surgery. "Sentinel node biopsy is a more precise way of surgically addressing breast cancer," explains Dr. Schwartz. "The procedure shows promise of predicting whether or not all of the lymph nodes draining the malignancy in the breast need to be removed, as we have done for years."
Sentinel node dissection involves injecting a radioactive isotope and/or a blue dye into a patient's breast before her surgery. This marker follows the same path that malignant cells would follow as they might spread from the tumor in the breast to the nodes in the axilla. The surgery begins as the dye reaches the first layer of nodes. This first or sentinel node is identified and removed, and examined for any signs of cancer.
Hopefully, the sentinel node acts as a predictor for the rest of the nodes in the axilla. If the sentinel node is positive for malignant cells, the other lymph nodes of the axilla should still be removed. It is hoped that if the sentinel node proves negative, then the remainder of the nodes will also be negative and need not be removed. It is too early to use the initial results of this study to abandon node dissection in the customary manner, but as further information is gained, the removal of the sentinel node only may prove promising.
First Uses
The procedure was originally used to treat melanoma cancer patients. Armando E. Giuliano, MD, Associate Director, Chief of Surgical Oncology at the John Wayne Cancer Institute in Santa Monica, was the first physician to use sentinel node dissection on breast cancer patients. In an effort to expand on the research being done by Dr. Giuliano, Dr. Schwartz started using sentinel node dissection at Jefferson. Dr. Schwartz has already performed more than 50 of these procedures. Once data is collected from at least 100 patients undergoing sentinel node biopsy, Dr. Schwartz will discuss the results with his colleagues across the country who are working on perfecting this procedure.
So far the procedure has been an accurate predictor of disease progression in 47 of the 50 women. "Three patients were found to have tumor spread to other nodes even though the sentinel node was negative. In an additional patient, the sentinel node(s) could not be found, even using both the blue dye and the radioactive isotope. Nevertheless, this procedure has the potential to be a significant advancement in the treatment of women by breast conservation," explains Dr. Schwartz. If the axillary node removal can be less extensive, the complications, such as arm swelling (lympedema), can be minimized, hospital stays may be shorter, convalescence will be more rapid, and patient care possibly even less costly.