Sentinel-Lymph-Node Biopsy
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Questions to Ask Your Doctor Before a Biopsy
Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR
 A biopsy is a sample of tissue removed by your doctor to
make a precise diagnosis. Biopsy procedures can range from a simple sampling of
skin under local anesthesia to surgical opening of the chest wall to remove a
portion of lung tissue. Biopsies may also be obtained during diagnostic
procedures such as endoscopy, colonoscopy, bronchoscopy, and others. Sometimes
doctors perform biopsies using a CAT scan or other radiological imaging
techniques to help identify the exact area to be sampled and avoid injury to surrounding organs.
There are several types of biopsies.
Excisional biopsy. If your doctor finds an area of interest or a suspicious finding
(for example, an enlarged nevus, or mole), often an excisional biopsy is
performed to remove the area in question in its entirety during the
biopsy.
Incisional biopsy. An incisional biopsy refers to removal of only a portion of the area of
interest (for example, sampling of a small fragment of tissue from a larger
breast lump).
Fine needle biopsy. A fine needle biopsy is used to remove cells or fluid by
suctioning through a long, thin needle.
Core needle biopsy. During a
core needle biopsy, the doctor inserts a special needle through a skin incision
that removes a very thin,
cylindrical piece of tissue.
The following questions can help guide your discussions with your doctor
concerning a biopsy (print these and take them with you to your doctor's visit):
Top Searched Biopsy Terms:
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cervical, cone, bone marrow, muscle, thyroid, punch, brain, fine needle aspiration,
colposcopy, skin
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What is a sentinel lymph node?
The sentinel lymph node is the first lymph node ("gland") to receive lymphatic drainage from a
tumor. It stands sentinel over the tumor, so to speak.
What is the lymphatic drainage?
Lymphatic drainage is a system of vessels that, like the system of veins, drains fluid from the
body and returns to a central location. The lymph fluid looks milky.
Why do a biopsy of the sentinel node?
Examination of the sentinel node ("gland") is performed to learn whether that node does or does
not have tumor cells within it.
How does a tumor spread?
Tumors have only three ways of spreading:
- By local invasion of adjacent tissue;
- Through the blood stream; and
- Through the lymphatic system.
Some tumors spread preferentially by the lymphatic system, meaning that they tend to spread
by this method.
How is it determined which is the sentinel node?
Which lymph node is the sentinel node for a given tumor is determined by injecting around the
tumor a tracer substance that will travel through the lymphatic system to the first draining
(sentinel) node and identify it. The tracer substance may be blue dye that can be visually
tracked or a radioactive colloid that can be radiologically followed.
What does the sentinel-lymph-node biopsy show?
Biopsy of the sentinel lymph node reveals whether there are or are not lymphatic metastases,
which are tumor cells that have journeyed from the original primary tumor into the lymphatic
drainage system.
If the sentinel node contains tumor cells, removal of more nodes in the area may be warranted.
If the sentinel node is normal, it is unnecessary to perform an extensive dissection of the
regional lymph-node basin.
Is the use of the sentinel-lymph-node biopsy common?
Yes. Sentinel-lymph-node biopsy has, for example, become a standard technique for determining
the nodal stage of the disease in some patients with malignant
melanoma.
Last Editorial Review: 9/9/2005
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