Sentinel lymph node injection for breast cancer (Lymphoscintigraphy)

Lymphoscintigraphy for breast cancer is an injection of radioactive pharmaceutical into the breast. The pharmaceutical then travels to the lymph channels of the breast and to the lymph nodes that drain the breast in the arm pit (axilla).

The surgeon who performs the surgery then identifies the lymph node with the most activity using a probe. The surgeon then samples that lymph node. A pathologist will look at the specimen. If it does not contain cancer cells, then the patient can be spared a more extensive lymph node dissection. More extensive surgery can lead to complications.

Often the injection prior to surgery is performed in the nuclear medicine department. Most commonly, it is done right before the surgery, but occasionally the day before. The procedure will be done by a radiologist who is aided by nuclear technologists. They will prepare the radiopharmaceutical and prep the patient. The radiologist will explain the procedure and answer any questions.

The radiopharmaceutical can contain lidocaine to make the injection more tolerable. The injection method will vary based on the radiologist. Some will place the needle behind the nipple or around it, while others will do it just under the skin. All are effective at identifying the sentinel lymph node.

The needle used is small and thin. Once the radiologist places the needle in the breast, he will inject the radiopharmaceutical. There is sometimes some discomfort during placement of the needle and during the initial part of the injection. This usually goes away as the injection continues.

The entire injection takes less than a couple of minutes. Most patients do not experience any significant discomfort. Many patients feel that the anticipation and associated anxiety is much worse then the procedure itself. There are very rarely any problems or pain afterwards. Most patients are comfortable and ready to proceed to surgery.

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