Who Is a Good Candidate for Sentinel Lymph Node Dissection?

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Sentinel lymph node dissection is a good option for women with early-stage, invasive breast cancer who have a low to moderate risk of lymph node involvement.

In these women, it is critical to find out if the cancer has moved beyond the breast. But it also makes sense to remove only the few lymph nodes most likely to provide the key information, rather than remove the many other nodes that were "minding their own business" taking care of other parts of the breast.

Sometimes, based on a physical exam, X-ray studies, or the size of a tumor, a surgeon will suspect or know that a woman's lymph nodes are involved. When the question is "HOW MANY lymph nodes are positive?" not just "ARE lymph nodes positive?" a standard axillary lymph node dissection, with multiple nodes removed, makes the most sense. This is because you don't want to leave behind a significant amount of cancer that may be in the nodes, AND you also want to know how many of the nodes are involved:

  • between one and three?
  • between four and nine?
  • more than ten?

Researchers have found that, as a woman moves up the ladder through these categories of lymph node involvement, her disease becomes significantly more serious and requires increasingly aggressive treatment.

In general, sentinel node dissection is NOT appropriate for:

  • anyone who is likely to have cancer in the lymph nodes
  • women with any prior surgery or treatment that could have altered the normal pattern of lymph drainage

In addition, sentinel node dissection may not be suitable for:

  • women over the age of 50 whose lymphatic flow may be altered by the wear and tear of the aging process; in this case, the sentinel node may not reliably indicate cancer involvement of the remaining lymph nodes
  • women who had chemotherapy before surgery to reduce the size of a large cancer or to treat many involved lymph nodes. This is because lymphatic flow may be altered by the inflammation and scar tissue that occurs as your body and the chemotherapy battle the tumor.

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