Sentinel Lymph Node Biopsy
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 
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Our doctors offer a conservative surgical procedure to many women who come to Memorial Sloan-Kettering for breast cancer care -- one that is easier to tolerate, speeds their recovery, and enables them to return sooner to their normal day-to-day activities. Called "sentinel node biopsy," this 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 this procedure, surgeons need to remove only one lymph node for examination -- the "sentinel" node, where cancer cells from a breast tumor would travel first. 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.
To date, surgeons at Memorial Sloan-Kettering have performed more than 4,500 sentinel node biopsy procedures, the most extensive institutional experience in the world. This experience led our doctors to develop predictive models to guide clinicians in evaluating the need for additional surgery.
This technique may also save many women from the most troublesome side effect of more extensive surgery -- lymphedema, or swelling of the arm.
Innovative Reconstruction Techniques
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.
Advanced Imaging Technology
Our radiologists have integrated new imaging techniques, such as breast magnetic resonance imaging (MRI), as tools for early detection and continue to develop even better options. Breast imaging specialists at Memorial Sloan-Kettering are now refining and demonstrating the benefits of stereotactic needle biopsy, a procedure for diagnosing a suspicious area that can be seen on a mammogram but is too small to be felt by touch. The procedure uses computer-imaging techniques to guide a needle into the breast to collect abnormal cells from a suspicious area observed on an x-ray. For many women, stereotactic needle biopsy can spare them a more uncomfortable and expensive surgical biopsy. It can also allow them to start their treatment sooner.
Our researchers are evaluating digital mammography, a technique that enables radiologists to produce an image of the breast in about five seconds (compared with four to five minutes with a traditional mammogram), and to refine the contrast of the image so that lesions can be seen more clearly. We are already using this test on a routine basis and are developing biopsy and treatment approaches linked to MRI.
Improvements in Systemic Therapy & Radiation Therapy
Women who need systemic medical therapy (such as chemotherapy) or radiation therapy benefit from Memorial Sloan-Kettering's expertise in these areas. We are a leading center for the development of innovative systemic therapies, including new hormonal approaches and vaccines. Almost every effective systemic therapy developed in the past decade has been studied and explored by members of our medical oncology team.
For patients with early stage breast cancer, Memorial Sloan-Kettering physicians pioneered a dose-dense chemotherapy regimen and led a national clinical trial that proved its benefits. Rather than giving several drugs simultaneously, our doctors administer chemotherapy agents singly at optimal doses in a defined sequence over a certain period of time. This approach makes chemotherapy more tolerable and more effective for eradicating tumors.
Our physicians developed and proved the therapeutic roles of paclitaxel (Taxol). We conducted laboratory studies of therapies that use monoclonal antibodies such as trastuzumab (Herceptin®) and translated these studies into clinically useful therapies for patients with advanced disease. We are now studying a number of related drugs that disrupt the cells' internal signaling so that they die.
Our researchers are also evaluating ways to target breast cancer more precisely, such as 3-D conformal radiation therapy and immunological therapies (including breast cancer vaccines) developed at Memorial Sloan-Kettering.
