Breast

Sentinel Lymph Node Biopsy (Breast)

OPERATION: Sentinel Lymph Node Biopsy (SLNB) — Breast
ANAESTHETIC: General anaesthesia
POSITION: Supine, arm on operative side extended at 90°.

INDICATION:
Invasive breast carcinoma with clinically and radiologically node-negative axilla. Pre-operative axillary USS showed no suspicious nodes [/ FNAC/core biopsy node-negative]. SLNB planned to stage the axilla accurately and avoid unnecessary full axillary dissection.

PROCEDURE:
WHO Checklist performed. Blue dye (Patent Blue V) injected periareolarly before scrubbing — patient warned about green urine and rare risk of allergic reaction. Radioisotope (Tc-99m colloid) injected [by nuclear medicine] [hours] pre-operatively — lymphoscintigram reviewed showing [number] hot nodes in the axilla. Arm abducted to 90°. Axilla prepared and draped.

ACCESS:
Short incision made over site of maximum radioactivity as detected by gamma probe. [If no clear signal: incision made just below and medial to the edge of the hair-bearing skin.] Axilla opened.

SENTINEL NODE IDENTIFICATION AND EXCISION:
Blue lymphatic vessels identified on opening the axilla — followed to the sentinel node. Gamma probe used to confirm maximum radioactivity — directed by shortest route to the sentinel node(s). Sentinel node(s) excised gently without disruption. Additional hot or blue nodes retrieved. [In-situ radioactivity checked after excision — background level confirmed, no further hot tissue.]