Sentinel lymph node procedure

A breast cancer diagnosis raises many questions - one of the most important being: Has the tumour already spread? This uncertainty often weighs heavily on those affected. The sentinel lymph node procedure (also known as Sentinel lymph node procedure The procedure is a gentle, precise intervention that avoids unnecessary stress.

At the Breast Centre am Englischen Garten, we combine state-of-the-art technology with years of experience. Our aim is to offer you the greatest possible safety with minimal physical strain. Because the more targeted the diagnosis, the gentler the treatment - and the better your quality of life during and after treatment.

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What does the sentinel lymph node procedure do?

The sentinel lymph node is the first lymph node in the drainage area of the tumour - the “guardian“, so to speak, of downstream lymph node stations. Lymph nodes are small, bean-shaped filters in our body that are connected to each other via a network of lymphatic channels (fine ducts). They intercept pathogens and cancer cells before they can spread throughout the body.

A professionally performed sentinel lymph node procedure can:

• Detect tumour cells early and reliably, even microscopically small ones (micrometastases)
• Avoid unnecessary major operations on many lymph nodes
• Significantly reduce the risk of lymphoedema (swelling due to lymph congestion)
• Minimise long-term consequences through gentle surgical technique
• Providing precise information about the spread of cancer for further therapy

In contrast to the conventional method (removal of many lymph nodes from the armpit), the sentinel lymph node procedure offers significantly fewer side effects and faster healing with comparable diagnostic certainty.

Course of the procedure

The sentinel lymph node procedure follows a standardised procedure that guarantees the highest medical standards and patient safety.

Preliminary investigation and planning

Every treatment begins with a comprehensive examination of your individual situation:

• Detailed discussion about your medical history and physical examination
• Imaging examinations (mammography, ultrasound, possibly MRI)
• Tissue sample (punch biopsy) for precise tumour identification
• Discussion in a team of doctors from various specialities
• Detailed information about the procedure and possible alternatives

The lymph node scintigraphy is performed on the day of the operation or the day before so that the substance can be optimally distributed.

Surgical intervention on the sentinel lymph node

The operation is performed under general anaesthetic or local anaesthetic with twilight sleep:

• Detection of the labelled lymph node with a special measuring device during the operation
• Gentle visualisation via small skin incisions (usually in the armpit)
• Precise identification and removal of the sentinel lymph node
• Carried out at the same time as tumour removal
• Additional operating time for the procedure: about 20 to 30 minutes

The gentle surgical technique preserves important nerves and vessels.

Tissue examination in pathology

After removal, the lymph node is examined in detail in the pathology department by microscopic examination of thin tissue sections. If necessary, special stains are used to better recognise cancer cells. Thanks to the close communication and fast processing routes between our pathology department and the surgeon, in many cases it is possible to obtain an initial sentinel biopsy result during the operation. This means that if metastases are present in the sentinel lymph node, axillary dissection (i.e. removal of the lymph node) can be carried out during the operation. The final findings are usually available after three to five working days and form the basis for further treatment planning.

What do the results mean?

Negative sentinel lymph node (no cancer cells found): Very good news - the tumour has probably not spread via the lymph channels. No further lymph node removal necessary. This is a favourable prognostic factor.

Positive sentinel lymph node (cancer cells found): Depending on the tumour situation and individual factors, further lymph nodes may need to be removed. The subsequent treatment is adjusted accordingly and more frequent follow-up examinations are carried out.

Aftercare and healing process

Structured follow-up care is provided after the procedure:

• Wound check and removal of the stitches after ten to 14 days
• Testing the mobility of the shoulder and arm
• Physiotherapy to prevent lymphatic swelling
• Regular cancer follow-up examinations

Most patients are able to resume their normal everyday activities after just a few days.

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Methods of sentinel lymph node diagnostics

Depending on the patient's individual tumour situation and medical factors, various proven techniques are used to locate the sentinel lymph node.

Scintigraphic labelling (nuclear medicine method)

In this nuclear medicine method, a low-level radioactive substance (tracer) is injected around the tumour or nipple. A tracer works like a harmless light source - it travels the same path as potential cancer cells and visualises the lymphatic channels on special images.

Advantages of scintigraphic labelling:

• Very precise localisation of the sentinel lymph node
• Minimal radiation exposure (as with a normal X-ray)
• Completely painless realisation
• Visualisation of the lymph drainage channels before the operation
• Detection during the operation with a special measuring device (gamma probe)

This method is particularly suitable for complex anatomical conditions and enables exact localisation even in the case of deeply located sentinel lymph nodes.

Dye labelling and combination process

Dye labelling with harmless blue dyes (patent blue or methylene blue) is a complementary or alternative method. The blue dye colours the lymph channels and the first lymph node so that the surgeon can easily recognise it during the operation.

The combination method of radioactive and dye labelling achieves detection rates of around 98 percent and is therefore the optimal method in many cases.

Frequently asked questions

What is the success rate?

The method has a detection rate of over 95 per cent. The false negative rate at experienced centres like ours is less than five per cent.

What side effects can occur?

The procedure has very few side effects. Rare complications include temporary loss of sensation, low risk of infection or allergic reactions to labelling substances.

Is the examination painful?

The preliminary examination is completely painless - you only feel the small prick during the injection. The operation is performed under anaesthetic, so you won't feel a thing.

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