Surgical Procedures: Sentinel Lymph Node Biopsy
Also known as: Sentinel node biopsy, SLN biopsy
What is a Sentinel Lymph Node Biopsy?
A sentinel lymph node (SLN) biopsy is the surgery done to remove one or a few specific lymph nodes. This is done to help determine if cancer has spread to other parts of the body.
How is it done?
- While you are asleep under anesthesia, the surgeon injects a blue dye and/or a radioisotope (a nuclear medicine dye) into the area of your tumor. In some cases, you may be given medication to numb the area but you will not be asleep.
- Once the dye(s) are injected, they are picked up by the lymphatic fluid in the area and travel to the local lymph node(s).
- An incision (cut) is made and the surgeon finds the lymph nodes with dye.
- The nodes that pick up the dye are the sentinel lymph nodes. They are removed and tested for cancer cells.
During this surgery, only the sentinel nodes are removed. The remaining nodes are left alone. This lowers the chance of getting a chronic swelling problem called lymphedema.
Will I stay overnight?
No. This is usually done as an outpatient or "same day" surgery. If you are having the SLN biopsy done at the same time as another surgery, you may need to stay overnight.
Could I need more surgery?
If cancer is found in one or more sentinel lymph nodes, you and your provider will discuss a treatment plan.
What is recovery like?
You and your provider will talk about what your recovery will be like. You will be up and moving the day of or day after surgery. There will be some changes to your normal schedule and exercise routine in the first week or so. After surgery, you could have side effects, such as:
- Blue urine and greenish colored stool for 24-48 hours after the injection of blue dye. You are not radioactive after receiving the radioactive tracer.
- Pain, numbness and/or sensitivity in the area of the surgery or in the limb where the surgery was done.
- A seroma could develop. A seroma is when lymph fluid collects in the area instead of draining its normal route. It is not worrisome but can be uncomfortable. Most go away on their own, over time, but may need to be drained in the office with a needle (a painless procedure).
- Lymphedema is a chronic swelling in a body part. There is a low risk of developing lymphedema after this procedure, though this risk is life-long.
Can I prevent infection?
Getting an infection after surgery is not common, but you can help prevent infection by:
- Taking a shower the night before surgery and washing your body with soap and water.
- On the second day after surgery, make sure to shower and clean the incision with soap and water. Pat dry and do not rub the incision. Do this every day, or at least every other day, to keep the incision site clean.
- Do not soak in a tub or go swimming. Your incision should not go under water.
- Always wash your hands before and after touching the incision or changing the dressing.
What will I need at home?
- 4 x 4 gauze pads and 1-inch paper tape to cover the incision if it is leaking.
- Clean, comfy pillow(s) to put under your arm or leg while sitting or to help with positioning at night.
How do I care for the incision?
Your provider will tell you when you should remove your bandage. After it is removed, you may shower, but do not scrub the incision. To dry, carefully pat the incision with a clean towel. Avoid lotions, powders or deodorant on or near the incision during the first 1-2 weeks until it is fully closed.
Often, dissolvable sutures are used so you won't see any sutures. This type of suture doesn’t need to be removed. On the outside, some surgeons use surgical glue over the incision to give added protection. Others use paper tape called "steri-strips" while some use nothing at all. Both glue and steri-strips can get wet in the shower.
How can I care for myself?
You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.
Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.
There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.
Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.
- Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.
This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.
American Cancer Society. (2019). Lymph node surgery for breast cancer. Retrieved from https://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer/lymph-node-surgery-for-breast-cancer.html
National Institutes of Health: US National Library of Medicine. (2018). Lymph node biopsy. Retrieved from https://medlineplus.gov/ency/article/003933.htm
National Institutes of Health: US National Library of Medicine. (2019). Sentinel lymph node biopsy. Retrieved from https://www.cancer.gov/about-cancer/diagnosis-staging/staging/sentinel-node-biopsy-fact-sheet