Axillary Surgery
Sentinel Node Biopsy
The sentinel nodes are the first few lymph nodes into which a cancer can drain. Sentinel node biopsy is the surgical procedure used to determine whether cancer has spread from the breast to the armpit lymph nodes. This involves the injection of a tracer material (performed prior to surgery at the edge of the nipple) which helps identify and locate the sentinel nodes at the time of surgery. Usually between 1 and 3 nodes are removed.
If the sentinel nodes are free of cancer, then cancer is unlikely to have spread, and no further lymph nodes need to be removed.
If there is cancer found in a sentinel lymph node, further surgery may be needed to remove more nodes from the armpit (axillary dissection) to check how many lymph nodes are affected.
Axillary Dissection
Axillary lymph node dissection involves removing all the nodes from the area under the arm to assess them for cancer spread. As the number of lymph nodes in the armpit is variable, the actual number of nodes removed is different for each woman. If indicated, this will be done during the initial breast surgery. However, it may also occur as a separate operation.
Targeted Axillary Dissection
Targeted axillary dissection (TAD) is a new tailored approach that can be used for some patients that are suitable for neoadjuvant chemotherapy (NACT). TAD involves the removal of a positive node along with the sentinel nodes following completion of NACT. This allows detailed assessment of the effect of chemotherapy on these nodes, and helps guide further treatment decisions for the axilla.