General Surgery

Sentinel Lymph Node Biopsy

OPERATION: Sentinel Lymph Node Biopsy (Breast)
ANAESTHETIC: General anaesthesia [may be combined with WLE or mastectomy]
POSITION: Supine with ipsilateral arm abducted

INDICATION:
Early breast cancer, clinically and radiologically node-negative axilla. Sentinel node identification planned with [isotope / blue dye / combined technique].

PROCEDURE:
WHO Checklist performed. [Isotope injection performed preoperatively by nuclear medicine / blue dye injection performed at start of anaesthesia periareolarly / both].

Transverse incision in the lower axillary hair-bearing skin. Dissection into axillary fat. Gamma probe / visual identification of blue-stained lymphatic channels used to locate sentinel node(s). [Number] hot / blue / hot-and-blue nodes identified and excised. [Any palpably suspicious nodes also excised].

Ex vivo count confirmed. Background axillary count measured. Node count [ratio reported].

Wound haemostasis confirmed. Wound closed with absorbable subcuticular suture.

[Frozen section analysis: [result]. If positive: proceed to axillary clearance / plan adjuvant radiotherapy as per MDT guidance.]

FINDINGS:
[Number] sentinel lymph nodes identified. Macroscopic appearance [normal / suspicious].

SPECIMEN: Sentinel node(s) labelled and sent to histopathology.
EBL: Minimal. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Regular analgesia. Results at multidisciplinary team meeting. Patient warned blue dye may discolour urine transiently and cause temporary skin discolouration.