Surgery

Prediction Tools Predict the chance of breast cancer's spread to the sentinel lymph nodes and from the sentinel lymph nodes to axillary lymph nodes more

Sentinel Lymph Node Biopsy

Today more breast cancers are being diagnosed at an early stage, thanks to improved screening. In 80 percent of the patients whose cancers have been detected early, axillary node dissection shows that the lymph nodes are cancer free. Rather than removing all the lymph nodes draining from the breast, our doctors offer a procedure called sentinel node biopsy. The new technique spares many women from extensive surgery to remove a cluster of lymph nodes from under the arm to see if they contain cancer cells.

With sentinel node biopsy, surgeons need to remove only one lymph node for examination -- the "sentinel" node, where cancer cells from a breast tumor would travel first, if they were to spread. Here's how it works: Before surgery, a radiolabeled dye is injected into the area around a woman's breast tumor. About one hour later, in the operating room, surgeons inject a special blue dye around the tumor and make a small incision in the armpit. To identify the sentinel lymph node, the surgeons track the path of the blue dye and also use a device that detects the radioactive source. They remove the sentinel node and, while the woman is still in the operating room, send it to a laboratory for examination.

If this lymph node turns out to be free of cancer, the remaining nodes can be left intact, and the surgery to remove the tumor is completed. If it contains cancer cells, the remaining nodes are also removed and analyzed using standard axillary node dissection. Sentinel node biopsy can be performed on patients who opt either for lumpectomy or mastectomy.

Memorial Sloan-Kettering has established the value of this technique for staging melanomas. We are one of only a handful of cancer centers now offering the technique to women with early-stage breast cancer. In a clinical trial involving 60 patients who had undergone both sentinel node biopsy and axillary node dissection, sentinel node biopsy was more than 99 percent accurate in predicting whether the remaining lymph nodes contained cancer cells in women with smaller tumors. To date, surgeons at Memorial Sloan-Kettering have performed more than 3,000 sentinel node biopsy procedures, one of the most extensive of institutional experiences in the world.

	Flash Player is required to view this video. CancerSmart Web Cast March 8, 2007 -- Larry Norton, Deputy Physician-in-Chief for Breast Cancer Programs presents, "Advances in the Prevention and Care of Breast Cancer." Run time: 90 minutes.

Besides reducing the chances of developing lymphedema, sentinel node biopsy offers other benefits: It can be done under local anesthesia, does not require an overnight hospital stay, decreases the risk of surgical complications, and results in lower medical costs. Our physicians hope to make the procedure part of standard treatment for women with early-stage breast cancer.

Breast Reconstruction

For women who have had a mastectomy, our surgeons offer innovative reconstructive techniques. A major advance in breast reconstruction, pioneered at Memorial Sloan-Kettering, is called "skin-sparing mastectomy." The surgeon removes the inner breast tissue and nipple, leaving a shell of skin in place; then the surgeon fills in the shell with tissue from the woman's abdomen and, later, reconstructs the nipple, resulting in a natural-looking breast.