Armpit (Axillary) Lymph Nodes:
Sentinel Node Biopsy (SNB):
Sentinel node biopsy is the procedure of choice for managing the armpit lymph nodes almost all breast cancers today. This basically means that the only the nodes that drain the breast are selectively removed avoiding the nodes draining the arm. This way the risk of arm swelling up in the future comes down to less than 2% from 40% when all armpit nodes are removed. This is a big difference for the patient. We perform this procedure using double dye technique so that nodes are not missed. We use methylene blue and indocyanine green (ICG). There are centers that perform this by using a radioactive substance. However, we have been able to effectively avoid using it.
Axillary Lymph Node Dissection (ALND):
Every breast cancer surgery involves removal of the lump and removal of the draining lymph nodes in the armpit or axilla. The nodes in the axilla are divided into 3 levels and at least 2 of these levels are removed while performing ALND surgery. The unfortunate part of this surgery is that about 40% of the patients develop swelling of their hand in their lifetime as the lymph nodes responsible for arm and breast are in the axilla. This is a very high number. This was a standard of care till about 15 years back for all breast cancers. Even today ALND is required for some the patients who come to us with involved nodes.
Axillary Reverse Mapping (ARM):
Every patient is not fortunate enough to reach us in early stage. There are times when patients have involved lymph nodes in the arm pit. Traditionally all these patients have to undergo ALND and have a very high lifetime risk of arm swelling up. We have devised a technique called axillary reverse mapping that would try to identify the lymphatic ducts coming from the arm and preserve those, removing all the lymph nodes. By doing this we may be able to reduce the risk of arm edema or swelling.