Axillary Lymphatics: A Case Study
Once the SLN is localized, a suture is placed through the node to provide traction. The node is then dissected free from the surrounding tissue. All feeding blood vessels, afferent and efferent lymphatics may be ligated.
Using the radiocolloid method, the gamma probe is used to locate any other SLNs and to confirm low radioactivity counts in the axilla and no residual SLNs. Ex vivo and in vivo radioactivity counts are recorded for each node.
The axillary tissue is also carefully palpated for any nodes that seem suspicious and that may not have taken up radioactive tracer or dye. Hemostasis is then obtained, and the wound is closed in layers. (Dirbas & Scott-Conner, 2011)
G. Number of Nodes Removed During SLNB
Multiple studies have demonstrated that removal of 2 to 3 nodes identifies 93% to 99% of node positive patients, and removal of 4 nodes identifies 100% of node positive patients (McCarter, et al., 2001) (Duncan, et al., 2004) (Zakaria, et al., 2007). The Axillary Lymphatic Mapping Against Nodal Axillary Clearance (ALMANAC) Trialists group found that 99.6% of node positive patients were identified by removing no more than 4 SNs. The false negative rate was 10% when 1 sentinel node was removed and 1% when 3 or …show more content…
In this study, 1,031 patients with clinically node negative invasive breast cancer were randomly assigned to undergo SLNB or standard ALND. Patients with a positive SLN underwent completion ALND. At 12 months, patients assigned to the SLNB group experienced much less arm lymphedema and sensory loss compared to the group assigned to standard ALND. Furthermore, drain usage, length of hospital stay, and time to resumption of normal day to day activities after surgery were significantly lower in the SLNB group. Overall, patient quality of life and arm functioning scores were better in the SLNB group as well (Mansel, et al., 2006). (Dirbas & Scott-Conner,
Using the radiocolloid method, the gamma probe is used to locate any other SLNs and to confirm low radioactivity counts in the axilla and no residual SLNs. Ex vivo and in vivo radioactivity counts are recorded for each node.
The axillary tissue is also carefully palpated for any nodes that seem suspicious and that may not have taken up radioactive tracer or dye. Hemostasis is then obtained, and the wound is closed in layers. (Dirbas & Scott-Conner, 2011)
G. Number of Nodes Removed During SLNB
Multiple studies have demonstrated that removal of 2 to 3 nodes identifies 93% to 99% of node positive patients, and removal of 4 nodes identifies 100% of node positive patients (McCarter, et al., 2001) (Duncan, et al., 2004) (Zakaria, et al., 2007). The Axillary Lymphatic Mapping Against Nodal Axillary Clearance (ALMANAC) Trialists group found that 99.6% of node positive patients were identified by removing no more than 4 SNs. The false negative rate was 10% when 1 sentinel node was removed and 1% when 3 or …show more content…
In this study, 1,031 patients with clinically node negative invasive breast cancer were randomly assigned to undergo SLNB or standard ALND. Patients with a positive SLN underwent completion ALND. At 12 months, patients assigned to the SLNB group experienced much less arm lymphedema and sensory loss compared to the group assigned to standard ALND. Furthermore, drain usage, length of hospital stay, and time to resumption of normal day to day activities after surgery were significantly lower in the SLNB group. Overall, patient quality of life and arm functioning scores were better in the SLNB group as well (Mansel, et al., 2006). (Dirbas & Scott-Conner,