![]() In patients with invasive ductal and lobular carcinomas, T1 and T2 lesions, merit consideration considered for sentinel lymph node biopsy. For example, cystosarcoma phyllodes tumors are not evaluated with sentinel lymph node biopsy. Sarcomatous tumors of the breast typically metastasize to the lung and do not involve the axillary lymph nodes. Sentinel lymph node biopsy is indicated as part of the staging workup of early-stage breast cancers of epithelial origin, such as ductal and lobular carcinomas, since these tumors metastasize to lymph nodes. Dissection superior to the axillary vein does not increase lymph node count for axillary dissection and can cause severe lymphedema and nerve injury. The surgeon should not encounter the brachial plexus during axillary dissection, provided that dissection is inferior to the axillary vein, which is an important landmark. Injury of these nerves causes numbness of the medial upper arm. Several small sensory nerves traverse the axillary fat pad, including the intercostobrachial nerve. Injury to the long thoracic nerve, which provides innervation to the serratus anterior muscle, causes winging of the scapula. There are two motor nerves of concern in axillary surgery: the long thoracic and the thoracodorsal nerves. Two branches off the axillary artery can be encountered during axillary surgery: the lateral thoracic artery and the thoracodorsal artery. The clavipectoral fascia lies deep to the pectoralis major muscle and invests the axillary artery and vein, as well as the axillary nerve. The surgeon divides the superficial fascia during sentinel lymph node biopsy. The axillary fat pad lies deep to the fascia superficialis of the axilla and has a different texture than subcutaneous fat. These lymph nodes are referred to by anatomists as the pectoral nodes and clavicular nodes. The identification of an axillary sentinel lymph node is typically in the axillary fat pad in the level I or level II lymph nodes of the axilla. ![]() To safely forego completion axillary dissection with a positive sentinel node, a patient should have a T1 or T2 primary tumor and less than three nodes involved with tumor. This fact is important because axillary dissection is a morbid procedure, with complications including lymphedema, nerve injury, ongoing pain, and lymphangiosarcoma. However, more recent evidence suggests that complete axillary dissection is not necessary for certain circumstances, even with a positive sentinel node. Traditionally, when a sentinel lymph node was positive, that was a trigger for performing a formal axillary dissection and removing all lymph nodes from the axilla. The identification, removal, and careful analysis of those lymph nodes can allow for the classification of the spread of the tumor and allow for prognostication. The principle of sentinel node identification and removal is that the sentinel node(s) will be affected by regional lymph node tumor spread before the rest of the lymph nodes in that regional nodal basin. Sentinel lymph node biopsy was developed to allow for assessment of the axillary lymph node status without a formal axillary dissection. Staging for breast cancer involves the evaluation of the regional lymph nodes. Summarize interprofessional team strategies for improving care coordination and communication to advance axillary sentinel lymph node biopsy and improve outcomes in breast cancer care.Review the appropriate evaluation of the potential complications and clinical significance of axillary sentinel lymph node biopsy.Describe the equipment required, preparation for, and technique of axillary sentinel lymph node biopsy for breast cancer.Identify the anatomical structures involved in and the indications, and contraindications for axillary sentinel lymph node biopsy for breast cancer.It also discusses the clinical significance and the importance of the interprofessional team. This activity reviews the indications and contraindications for the procedure, the relevant anatomy, the technique of the procedure, and potential complications. Sentinel lymph node biopsy for breast cancer is an essential part of staging patients with early-stage breast cancer.
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