University of Virginia Health System

UNIVERSITY OF VIRGINIA SURGEONS PERFORM MINIMALLY INVASIVE BIOPSY DURING BREAST SURGERY

Traditionally during breast surgery, doctors remove multiple lymph nodes in the arm for biopsy. Last year close to 200,000 women underwent axillary dissection (AD) in which 15 or more lymph nodes and surrounding tissue are removed. Complications can arise from AD, such as lymphedema (swelling caused by excess fluid build up), a persistent burning sensation and nerve damage to the arm resulting in limitation of shoulder movement. Sentinel node biopsy involves removing as few as one pea size lymph node. Less node removal permits a smaller incision, reduces the risk of infection and shortens patient recovery time.

If we find upon examination that the sentinel node is not cancerous, we believe we can assume the other nodes are also cancer free, explains Dr. Marcia Moore, a surgical oncologist at U.Va. Sentinel node biopsy appears to be a real advancement in breast cancer care and could become the gold standard within five years.

Just prior to the biopsy, methylene blue dye is injected into the tumor. This gives the tumor, the surrounding tissue and the sentinel node a bluish tint making them easy to locate. Surgeons may also inject patients with a radioactive isotope, which travels to the lymph nodes and accumulates. The isotope's location is detected using a gamma counter.

Sentinel node biopsy offers women the possibility of having only one node removed; however, if the sentinel node is found to have cancer, surgeons will remove the other nodes. A pathologist examines sections of the node during the surgery, so the surgeon knows immediately how to proceed.

Dr. Moore is one of 20 surgeons on a panel of the American College of Surgeons Oncology Group that designed study protocols for two trials assessing the impact of sentinel node surgery for women undergoing a lumpectomy for early stage breast cancer. The multi-center trials are expected to enroll 7,600 women over nearly four years. U.Va. Health System is one of eight sites currently enrolling patients.

We hope that eventually widespread use of sentinel node biopsy will lead to less aggressive surgery for women with early-stage breast cancer, said Moore.

The Cancer Center at the University of Virginia Health System is one of only 13 clinical centers designated by the National Cancer Institute. At U.Va., a team of healthcare providers offer comprehensive management of breast cancer, including prevention, screening, diagnosis and treatment, and conduct innovative research leading to new therapies and services.

December 3, 1999