Sentinel Lymph Node Biopsy in Sharjah
Medically reviewed by Dar Al Kamal Team
What is a sentinel lymph node biopsy?
A sentinel lymph node biopsy is a targeted way of checking the lymph nodes in the armpit for breast cancer. Lymph fluid from the breast drains along channels to a small group of nodes first, and these first nodes are called sentinel nodes, from the word for a guard. If cancer cells have travelled from the breast, the sentinel nodes are where they are most likely to be found.
Instead of removing the whole group of armpit nodes, the surgeon traces the drainage path and removes only these first few, usually a small number. The laboratory then examines each node in detail. A clear result spares you a larger armpit operation, and the arm keeps more of its normal lymph drainage.
At Dar Al Kamal Hospital, Sharjah, sentinel lymph node biopsy is performed in-house by the general surgical team as part of breast cancer surgery, described on the breast surgery page.
Who needs it
Sentinel lymph node biopsy is offered to women with invasive breast cancer whose armpit nodes appear normal on examination and ultrasound before surgery. It is also used in some women having a mastectomy for pre-invasive cancer, known as ductal carcinoma in situ, because the nodes are harder to trace once the breast has been removed.
If the armpit ultrasound shows a node that looks abnormal, that node is usually sampled first with a needle, using breast fine needle aspiration or a core biopsy. When that sample confirms cancer in the node, the surgeon plans a fuller armpit operation instead, and the sentinel technique is set aside.
The result shapes the rest of your treatment. Together with the breast pathology, it helps the oncology team decide whether chemotherapy, radiotherapy to the armpit or further surgery would benefit you, so this small operation carries a great deal of useful information.
What happens
A tracer is injected into the breast, usually near the nipple or around the cancer, either shortly before the operation or once you are asleep. The tracer flows along the lymph channels to the sentinel nodes in the same way cancer cells would. Your surgeon explains which tracer is used for your operation. When a blue dye is used, it stains the sentinel nodes blue so the surgeon can see them, and a handheld probe is used with other tracers to locate the nodes through the skin.
Under general anaesthesia, the surgeon makes a small incision in the armpit crease, follows the tracer to the sentinel nodes and removes them. Any other node that feels firm is removed at the same time. The incision is closed with dissolving stitches.
The biopsy is almost always part of a lumpectomy or mastectomy, done in the same anaesthetic, so the armpit wound heals alongside the breast wound and the whole operation happens in one visit.
Preparing for it
Preparation follows your main breast operation: a pre-operative assessment, blood tests, an anaesthetic review and clear fasting instructions. Tell the team about any allergy, including any reaction to dyes, contrast or skin products, because this guides the choice of tracer.
Shaving the armpit is best avoided in the days before surgery, since small nicks raise the chance of infection; the team prepares the skin on the day. Bring loose, front-opening tops that are easy to put on over a sore armpit. If surgery falls near Ramadan, raise it early so fasting and medicines are planned together.
Afterwards
The armpit feels sore and tight at first, and the skin of the inner upper arm often feels numb or tingly, because a small skin nerve runs through the area. This usually eases gradually. If a blue dye was used, your urine may turn blue-green for a day or two, and the breast skin can carry a blue tint that fades slowly over the following months. Both are expected effects of the dye.
Start the gentle arm and shoulder exercises you are shown from the day after surgery, lifting the arm a little higher each day. Keep the armpit wound clean and dry. In the Sharjah heat, leave out deodorant on that side until the wound has healed, and wear loose cotton clothing to keep the area cool.
The laboratory result on the sentinel nodes is discussed at your results appointment, together with the breast pathology.
Contact the hospital promptly if the armpit becomes hot, red or increasingly swollen, if the wound leaks, or if you develop a fever. Contact your surgeon if your hand or arm starts to swell, feel heavy or tight, so it can be assessed early.
Cost and insurance
Sentinel lymph node biopsy is usually approved as part of the breast cancer operation, supported by the biopsy report and imaging. The laboratory examination of the nodes and the tracer are sometimes listed as separate items on the approval. Dar Al Kamal Hospital, Sharjah can help you confirm what your plan covers on 06 599 7777.
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Frequently asked questions
What are the risks of a sentinel lymph node biopsy?
Sentinel lymph node biopsy carries risks of bleeding, infection, a fluid collection in the armpit and numbness of the inner upper arm. An allergic reaction to the tracer dye is uncommon but possible, and the team is prepared for it. Arm swelling, called lymphoedema, and a tight cord under the arm can occur, although less often than after full armpit surgery.
What happens if cancer is found in the sentinel node?
If cancer is found in a sentinel node, the oncology team and your surgeon discuss the next step with you. Depending on how much cancer is present and your other results, this may be no further armpit surgery, radiotherapy to the armpit, or an operation to remove more lymph nodes.
Why does my urine look blue after surgery?
Blue or green urine after a sentinel lymph node biopsy comes from the blue dye used to find the nodes, which leaves the body through the kidneys. It is expected and harmless, and clears within a day or two.
Will a sentinel lymph node biopsy cause arm swelling?
Arm swelling, called lymphoedema, is less likely after a sentinel lymph node biopsy than after removal of all the armpit nodes, but it can still happen. Keeping the arm moving, protecting the skin from cuts and burns, and reporting early swelling help it to be managed promptly.
How many lymph nodes are removed in a sentinel node biopsy?
A sentinel lymph node biopsy usually removes a small number of nodes, often between one and three. Any node that looks or feels abnormal during the operation is removed as well, so the exact number differs between people.
Can I have a sentinel node biopsy without breast surgery?
A sentinel lymph node biopsy is almost always done together with a lumpectomy or mastectomy, in the same operation. Your surgeon plans the timing with the rest of your treatment, and occasionally it is done at a separate time.
Is a sentinel lymph node biopsy covered by insurance?
Most UAE insurance plans cover a sentinel lymph node biopsy as part of approved breast cancer surgery. The laboratory analysis may be listed separately. Confirm your cover with Dar Al Kamal Hospital, Sharjah on 06 599 7777.
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