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Sentinel lymph node biopsy for breast cancer is an essential part of staging patients with early-stage breast cancer. This activity reviews the indications and contraindications for the procedure, the relevant anatomy, the technique of the procedure, and potential complications. It also discusses the clinical significance and the importance of the interprofessional team. Objectives: Identify the anatomical structures involved in and the indications, and contraindications for axillary sentinel lymph node biopsy for breast cancer. Describe the equipment required, preparation for, and technique of axillary sentinel lymph node biopsy for breast cancer. Review the appropriate evaluation of the potential complications and clinical significance of axillary sentinel lymph node biopsy. Summarize interprofessional team strategies for improving care coordination and communication to advance axillary sentinel lymph node biopsy and improve outcomes in breast cancer care. Access free multiple choice questions on this topic.

Staging for breast cancer involves the evaluation of the regional lymph nodes. Sentinel lymph node biopsy was developed to allow for assessment of the axillary lymph node status without a formal axillary dissection. The principle of sentinel node identification and removal is that the sentinel node(s) will be affected by regional lymph node tumor spread before the rest of the lymph nodes in that regional nodal basin. The identification, removal, and careful analysis of those lymph nodes can allow for the classification of the spread of the tumor and allow for prognostication. Traditionally, when a sentinel lymph node was positive, that was a trigger for performing a formal axillary dissection and removing all lymph nodes from the axilla. However, more recent evidence suggests that complete axillary dissection is not necessary for certain circumstances, even with a positive sentinel node. This fact is important because axillary dissection is a morbid procedure, with complications including lymphedema, nerve injury, ongoing pain, and lymphangiosarcoma. To safely forego completion axillary dissection with a positive sentinel node, a patient should have a T1 or T2 primary tumor and less than three nodes involved with tumor.[1]

Sentinel lymph node biopsy is a less morbid procedure than formal axillary dissection. Risks of the procedure include bleeding, infection, nerve injury, lymphedema, and the need for additional surgery in the case of extensive nodal involvement or recurrent axillary disease. It is considered a low-risk procedure.

On the day of surgery, the patient comes into contact with many specialties, and even more, are involved during their cancer care. All caregivers should be aware of their other colleagues administering care, and should communicate with them frequently, functioning as an interprofessional team. Following surgery, a medical oncologist or surgeon typically spearheads treatment plans, ideally with the help of an interprofessional tumor board. Tumor board involves surgeons, medical and radiation oncologists, radiologists, pathologists, nursing staff, and care coordinators so that all members of the team are aware of the treatment options and plan. Nursing care will be crucial in the postoperative setting, administering medication, and closely monitoring patient status so they can inform the clinicians of any status changes. If the patient has any issues with arm mobility after surgery, physical therapy can be employed. A lymphedema clinic is useful if the patient develops lymphedema, though this is rare with just a sentinel lymph node biopsy. Finally, cancer support groups can be of great benefit to patients. The interprofessional team approach, as outlined above, will yield the best results in these cases. [Level 5]

Nurses should be aware that when using isosulfan blue or methylene blue to identify the sentinel node, it can temporarily change the patient's skin tone and will also temporarily cause the patient's urine to be green.