Tip:
Highlight text to annotate it
X
>>> Dr. JAY HARNESS: The indications for sentinel lymph node biopsy are several. If a patient
is diagnosed by core biopsy with an invasive breast cancer, then sentinel lymph node biopsy
is important in staging the axilla and staging the patient to see if the cancer is gone from
the breast to the axilla, therefore upgrading the stage of the patient to certainly at least
stage II.
Now, questions come up about the use of sentinel lymph node biopsy if somebody has in situ
breast cancer. It is kind of a tricky question, one that we as breast cancer surgeons actually
debate a fair amount among ourselves, and let me sort of summarize what I think the
thinking on that is.
Number one, if you have got a small, low-grade or small intermediate grade in situ breast
cancer, there are no indications for performing sentinel lymph node biopsy in that set of
circumstances. However, it gets trickier with high-grade DCIS, particularly if the imaging
studies suggest that possibly there may be an invasive area associated with that high-grade
DCIS, and particularly the bigger the area of the high-grade DCIS, the more concerned
we all are that there may be involvement of the sentinel lymph nodes.
Now, where does this become important? It becomes important particularly if a patient
is going to have a mastectomy. We could argue that if the patient is going to have a lumpectomy
and at that lumpectomy we find invasive cancer, then we could go back secondarily at a second
surgery and do the sentinel technique at that point, and that is true. We can do it that
way. There is a little fall off in accuracy because of the disruption of some of the lymphatics
in the breast, but the bottom line is that after a lumpectomy, if we find an invasive
cancer that we did not expect, yes we can go back and do a subsequent sentinel lymph
node biopsy.
If a patient is having a mastectomy, we cannot do that. Our bridges are burnt at that point,
and so an example question that I got recently about, “My doctor, my core biopsy is unclear
whether I have in situ or invasive”.
I think if you are unclear, given the low side effects of doing sentinel node biopsy,
then I think the smart thing to do is a sentinel node biopsy if you are going to have a mastectomy
because frankly, if you find an invasive cancer, we cannot do the sentinel lymph node biopsy
later on.
Those are sort of the big areas of discussion and debate. One other area of debate is if
we are doing a prophylactic mastectomy on the other side, is there a role for sentinel
node biopsy? The answer is usually ‘no’ and there are now reports out that support
that, particularly if a patient’s had breast MRI and the breast MRI of the other side is
negative, the mammograms are negative, the odds that there is a hidden, invasive cancer
when you’re doing the prophylactic mastectomy, are virtually zero.
But again, in my line of work we never say ‘never’ and we never say ‘always’,
but the odds are so low that it’s hard to justify with a prophylactic upfront, no-cancer
kind of mastectomy during a sentinel lymph node biopsy.
So I hope that clears up the issues of the indications of a sentinel lymph node biopsy,
some of the debate around the subject, done my best to try and share that information
with you. Thank you so much.