Understanding Breast Biopsy
with Dr. Lyle Henry, CSM surgeon
After a lump or suspicious tissue in a woman’s breast is biopsied and found to be cancerous, the next important step is determining if the cancer has spread to the lymph nodes.
"The status of the nodes in her armpit determines the likelihood of a woman being cured and how she will be treated after surgery," said Dr. Lyle Henry, a surgeon with Columbia – St. Mary’s.
About 80% of breast cancers have not spread to the nodes. An even higher percentage of those involving small breast lumps have not spread to the nodes.
Until recently lymph node biopsy always involved removal of all the fat tissue in a woman’s armpit, so that physicians could examine all the nodes.
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In the old days every woman with breast cancer had a mastectomy and her nodes removed at the same time. Now, I would say in our practice maybe eighty-five to ninety percent of women elect breast conservation.
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Removal of all the lymph nodes requires an overnight hospital stay, two to three weeks with a drainage tube in place to remove lymph fluid from the area, and follow-up physical therapy to help a woman regain lost arm strength.
Approximately 5% to 10% of women develop long term problems, including pain or discomfort in the area or swelling of the arm or hand, called lymphedema.
About lymphedema
"Lymphedema occurs because, if you take all the nodes out, a woman may develop scarring in the lymph channels. Radiation creates even more scarring and the lymph fluid can’t get out of her hand," Dr. Lyle Henry explained.
Lymphedema usually occurs immediately following radiation treatment for the cancer , but may also arise years later and it may become a chronic condition.
There are treatments for it — compression bandages, massage, even exercise for the affected arm — but the best course of action would be to minimize scarring in the first place.
What’s a sentinel node biopsy?
By identifying and removing for biopsy only those nodes which are most likely to be cancerous, scarring is minimized. Called sentinel node biopsy, the procedure is done at major medical centers including Columbia-St. Mary’s.
When cancer spreads it will move from the lump through the lymph ducts to the first set of nodes nearest it. These are the sentinel nodes. Identifying and performing biopsies on these first, will reveal if the cancer has spread.
If it has, a complete lymph node dissection can take place. If it has not, and with today’s advances in early breast cancer detection, these are the most frequent cancers treated, no further dissection is likely to be needed.
Most women with invasive breast cancer can have this procedure. However a few cannot.
Who shouldn’t have one?
While sentinel node biopsy may be performed on most women diagnosed with breast cancer, there are a few for whom this form of biopsy is unreliable, primarily because the pathways of the lymph system have been blocked or altered.
These include women who have had radiation therapy or operations on their breasts, women who have enlarged lymph nodes under their arms, and women who have already had their cancer spread to their lymph nodes.
In addition, women who have already had a mastectomy cannot have this procedure because there is no way to establish the pathway to sentinel nodes. Also, women whose cancers are larger (over 5 cm) have a higher incidence of lymph node spread and a physician may recommend a standard lymph node dissection.
Is a sentinel node biopsy right for you? Click here to read more.
