The Role of Sentinel Lymph Node Biopsy in the Management of Early Breast Cancer with Negative Axillary Lymph Node

Abstract

Background: pathological examination of the axillary lymph nodes continue to stay a gold method to determine metastatic disease to the axilla in early breast cancer. Biopsy of a sentinel lymph node is less invasive and reduces disruption of lymphatic channels than axillary sampling or axillary dissection. Aim: the purpose of the study was to describe the role of sentinel lymph nodes in the treatment of early breast cancer with negative axillary nodes.Patients & method: An observational descriptive study was carried out on women undergoing sentinel lymph node biopsy from 1st of March 2021 to 1st April 2022 at Smart Health Tower Hospital in Sulaimani, Iraq. (41) Samples were selected using a purposeful, convenient sampling technique. The study tools included a structured interviewing questionnaire, and an observational checklist. It includes 7 parts. Part one: Socio-demographic feature, Part two: History of present illness, Part three: clinical examination of the breast and axilla, Part four: Investigations (Breast screening). Part five: Surgical and non- surgical treatment. Part six: surgical technique for sentinel lymph node biopsy (injection of blue dye methylene 0.079g/ml (0.3mg diluted in 5 ml distal water), the dye is injected into parenchyma cells beside the tumor peritumoral or in to subareolar area or perareola. Part seven: Post -operative complications. Results: The identification rate of sentinel node was 97.56%. Pathology results: 57.50 % did not have metastatic disease (node negative), 42.50% had metastasis disease (positive node in axilla). 9.75% (patients with 3 or > positive lymph node metastasis with macrometastasis >2mm) underwent a second operation to remove the metastatic axillary lymph node (p= 0.000).Conclusion: Biopsy of a sentinel lymph node through Methylene blue injection remains an effective and reliable way to determine whether axillary lymph nodes have metastatic disease, and to make decisions regarding adjuvant systemic therapy