Sentinel Lymph Node Biopsy for Breast Cancer: Who Needs It and When Can It Be Skipped? — Transcript

Full transcript

1. 0:00Hello. In this video, I will be talking
2. 0:02about sentininal lymph node biopsy.
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14. 0:29[Music]
15. 0:34So what is a sentininal lymph node and
16. 0:37what is a sentininal lymph node biopsy?
17. 0:40So a sentininal lymph node is a the
18. 0:42first lymph node that drains a
19. 0:44particular tissue. So anywhere in the
20. 0:46body is drained by or sort of cleared or
21. 0:50cleaned up by lymph nodes. In the case
22. 0:52of breast cancer, sentininal lymph nodes
23. 0:55reside in the armpit. So imagine if you
24. 0:57had a tumor in the left breast, the
25. 1:00lymph fluid will drain into the armpit
26. 1:03lymph nodes or the axillary lymph nodes.
27. 1:06And one to four of those nodes are kind
28. 1:09of the sentry nodes or the sentinel. A
29. 1:12sentinel is a guard. And remember lymph
30. 1:14nodes are doing a job by catching up
31. 1:17infection and tumor cells. If we can
32. 1:20identify the one or two or three or four
33. 1:24lymph nodes that are the centry nodes,
34. 1:26it can tell us a lot and it can help
35. 1:28guide our treatment which I'll get to in
36. 1:30just a moment. So again, a sentininal
37. 1:33lymph node and I'm saying node and then
38. 1:35I say one to four nodes because the
39. 1:38average that we see is between one and
40. 1:41four. The surgeon to identify the
41. 1:44sentininal lymph node will inject a blue
42. 1:47dye and or a radio tracer. And this is
43. 1:51done under the nipple or near the tumor.
44. 1:54And this can even be done in somebody
45. 1:56who's had a mastctomy after the
46. 1:58mastctomy because it seems that the same
47. 2:01nodes will drain the mastctomy scar as
48. 2:04drain the breast itself. That's relevant
49. 2:07only if under particular situations. But
50. 2:10I did want to mention that. So the dye
51. 2:13and or the radioracer are injected and
52. 2:16then in the operating room the axilla an
53. 2:19incision is made under the arm and we
54. 2:22use the radioracer to find the strongest
55. 2:25lymph node the strongest signal that
56. 2:28node that's taken up the most of that
57. 2:29radioracer or the most of the blue dye.
58. 2:33And we will some surgeons use just one
59. 2:36and some another and some will use both.
60. 2:39The highest yield rate or identification
61. 2:42rate is with both. But most surgeons now
62. 2:45are so fil with the procedure and so
63. 2:48experience that both are not necessarily
64. 2:50needed. We are successful in in
65. 2:54identifying the sentininal lymph node
66. 2:56more than 95% of the time. When the
67. 2:59sentininal node is identified, it's
68. 3:01removed from the armpit and sent to the
69. 3:04lab where it's processed and later
70. 3:07reported out. We can do a frozen section
71. 3:10where we just look at the frozen lymph
72. 3:12node, but you can have false positives
73. 3:15and false negatives. So, we really don't
74. 3:17like to do frozen lymph node
75. 3:19assessments, but rather send the full
76. 3:21specimen for full processing. The
77. 3:24surgeon doesn't know how many lymph
78. 3:26nodes they're removing. It's really
79. 3:28important to know that we can't look in
80. 3:30somebody's armpit and say, "You have 35
81. 3:33lymph nodes or you have eight lymph
82. 3:34nodes." It's really based on what they
83. 3:37see in terms of the die and the radio
84. 3:40tracer, the sort of signal that we get
85. 3:43from those lymph nodes.
86. 3:45So I just want to take a quick aside.
87. 3:47I've referred to sentininal lymph node
88. 3:49biopsy and sentininal lymph node
89. 3:51assessment. I the reason I use the word
90. 3:54assessment is because a biopsy is when
91. 3:56we take just a part of something. So if
92. 3:59you have a a biopsy of a tumor, we don't
93. 4:02take the whole tumor. you just biopsy
94. 4:04and take a piece of it. When a
95. 4:06sentininal lymph node is removed, we're
96. 4:08removing the whole node. And so for me,
97. 4:11assessment feels more accurate. But you
98. 4:13will see it referred to as a sentininal
99. 4:16lymph node biopsy or a sentininal lymph
100. 4:18node assessment. They are exactly the
101. 4:20same thing. So why do we do this? We do
102. 4:23this procedure to help us stage the
103. 4:26cancer. The most important thing we want
104. 4:28to know is, do you have cancer in the
105. 4:31lymph nodes?
106. 4:33If the lymph nodes are clinically
107. 4:35negative, they're not enlarged, we're
108. 4:38not seeing them, uh we're not feeling
109. 4:40hard lymph nodes or we're not seeing
110. 4:42them on imaging where they look really
111. 4:44suspicious. If the sentininal lymph
112. 4:46nodes are negative, it is very likely
113. 4:49that all the other lymph nodes in the
114. 4:51armpit are also negative. And this will
115. 4:54spare somebody from having all those
116. 4:56lymph nodes removed. So, it's a less
117. 4:59morbid procedure, fewer side effects,
118. 5:01and it's actually a little more precise
119. 5:04because more sections are taken of
120. 5:07what's considered a high yield lymph
121. 5:08node, a lymph node that we know is very
122. 5:11likely to be the ones where those cancer
123. 5:13cells were sort of caught up. If the
124. 5:16lymph nodes are positive in the
125. 5:18sentininal lymph node, there are couple
126. 5:20different branch points. One is let's
127. 5:22say they're all positive and they're
128. 5:24really positive. It is very likely that
129. 5:27you will be advised to have a full
130. 5:30axillary lymph node dissection and we
131. 5:33have a videotape about that. So I'm not
132. 5:35going to go into that but imagine if we
133. 5:37remove three lymph nodes and they all
134. 5:39have cancer in them and it's not subtle
135. 5:41then we are going to want to make sure
136. 5:43that we're not leaving any lymph nodes
137. 5:45behind in the armpit to come back down
138. 5:48the road. Now, here's something really
139. 5:50interesting to know about. If you have
140. 5:52one to two positive lymph nodes only,
141. 5:56and ideally you have a negative
142. 5:58sentininal lymph node as well, it's been
143. 6:01shown in a clinical trial that you
144. 6:03actually do not necessarily have to have
145. 6:06a full lymph node dissection if you will
146. 6:09be getting radiation therapy. So, if
147. 6:12you're going to have radiation therapy,
148. 6:14the the armpit part of the breast and
149. 6:17the armpit are likely to be included in
150. 6:19the radiation field. And if you had a
151. 6:22low tumor burden in your lymph nodes,
152. 6:24again, one or two lymph nodes, then you
153. 6:27can likely omit having a full axillary
154. 6:31node dissection. Now there's another in
155. 6:34between state where people have a
156. 6:36microscopic focus of cancer in the lymph
157. 6:39nodes one or two very small areas and
158. 6:42treatment in that case depends on a lot
159. 6:45of other things. The likelihood that the
160. 6:47tumor is going to come back based on the
161. 6:49tumor biology for example. Does
162. 6:52everybody have to have a sentinel lymph
163. 6:54node biopsy?
164. 6:56It turns out that not everybody does. If
165. 6:59you are 70 and over, if your tumor is
166. 7:02hormone receptor positive, if your tumor
167. 7:04is her two negative, if the lymph nodes
168. 7:07are clinically negative, and if you are
169. 7:09going to take endocrine therapy, meaning
170. 7:11temoxifen or an aromatase inhibitor, we
171. 7:14don't need to do a sentininal lymph
172. 7:16node. In fact, we are so confident that
173. 7:18you don't need to have a sentininal
174. 7:20lymph node assessment done because of a
175. 7:23randomized trial and this is now in the
176. 7:26society of surgical oncologies sort of
177. 7:29what uh cannon it's in the choosing
178. 7:31wisely campaign that we can deescalate
179. 7:34and omit this procedure in people who
180. 7:38meet all of those criteria. You know,
181. 7:41it's very likely that we'll expand the
182. 7:43criteria so more and more people can
183. 7:45have a sentininal lymph node omitted.
184. 7:47They don't have to have it, but at this
185. 7:49point, these are the criteria for
186. 7:51omitting a sentininal lymph node. What
187. 7:53are what's the impact in terms of
188. 7:55long-term effects? Well, the thing we
189. 7:57worry about the most, as you probably
190. 7:59know, is swelling of the arm and chest
191. 8:01wall and breast. That's called
192. 8:03lympadeema. And we have a very thorough
193. 8:05video about lympadeema that you can
194. 8:08watch that has a lot of tips. many of
195. 8:10them from the viewers in the yearbook
196. 8:12community. But in brief, sentininal
197. 8:14lymph node assessment, biopsy or
198. 8:16dissection does not eliminate but does
199. 8:19reduce the risk of lympadeema. So it's a
200. 8:22very helpful thing to do less surgery
201. 8:26and it's one reason that we're really um
202. 8:29pleased with the data supporting use of
203. 8:31sentininal lymph node assessment. If you
204. 8:34have a sentininal lymph node procedure,
205. 8:36you're going to have an incision very
206. 8:38small under your arm. Your arm may feel
207. 8:40heavy, boggy, you may have numbness, and
208. 8:43you may end up with lympadeema. So, it's
209. 8:45really important to be aware of those
210. 8:47side effects and to get early attention
211. 8:50if you develop swelling in your hands,
212. 8:53in your arm, or in your chest wall. And
213. 8:56if you want to learn more about
214. 8:58sentininal lymph node, should it be done
215. 9:00in your case or can it be omitted? I
216. 9:02want to invite you to go to yerba.com.
217. 9:04Yerba.com takes your medical records
218. 9:06once you give us access or upload your
219. 9:09medical records from anywhere in the
220. 9:11world and generates a report of
221. 9:13everything we know about your tumor and
222. 9:16everything that's been done in your
223. 9:17case, all the test results and all the
224. 9:20procedures that you've had. It then
225. 9:22cross references everything we know
226. 9:24about your specific case with the latest
227. 9:26medical evidence and generates a list of
228. 9:28options, things you may hear about at
229. 9:31when you go see your cancer team and
230. 9:34tells you the pros and cons of these. It
231. 9:36also suggests questions that you can ask
232. 9:38your medical team. Helps you go into
233. 9:40that appointment prepared to hear what
234. 9:42you're going to hear, which makes it so
235. 9:44much easier to absorb the jargon and all
236. 9:47the stuff that the medical team will
237. 9:48throw at you. We are jargon free, 100%
238. 9:51guaranteed. Anyway, thanks for watching
239. 9:53and we'll see you next time.
240. 9:56[Music]