Lymphoscintigraphy for breast cancer is a common and helpful procedure done prior to surgery for breast cancer. This procedure helps the surgeon identify the first lymph node (sentinel node) that the tumor drains to. We can then sample that lymph node for cancer.
What is 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 sentinel lymph node, or first lymph node that drains the breast.
Why is lymphoscintigraphy done?
Following a lymphoscintigraphy, the surgeon who performs the breast surgery identifies the sentinel lymph node using a probe. The surgeon 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.
What is the sentinel lymph node?
It’s the first lymph node to receive lymph drainage from a tumor. If this lymph node does not have cancer cells then the cancer has likely not spread to other lymph nodes or distant sites in the body.
Are you sedated for the procedure?
No, you are awake.
This procedure can tell us that if the sentinel node is free of cancer, then it’s unlikely that the cancer has spread beyond the breast. This can spare the patient a more extensive surgery and give us information about the prognosis.
The injection is performed in the nuclear medicine department prior to surgery. Most commonly, it is done right before the surgery, but occasionally the day before. The procedure will be done by a radiologist who is helped by a nuclear technologist.
The technologist 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 the injection 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.
Does a sentinel node injection hurt?
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 for surgery.
Sentinel node injection complications
Complications are very rare. Allergic reactions can occur to from the radiopharmaceutical.
Lymphoscintigraphy (sentinel node injection): summary
Lymphoscintigraphy for breast cancer is commonly used to find the sentinel or first lymph node that the breast cancer drains to. This useful procedure helps us with prognosis and prevents more extensive surgery which can lead to complications.