Sentinel Lymph Node Biopsy
Prediction Tools Predict the chance of breast cancer's spread to the sentinel lymph nodes and from the sentinel lymph nodes to axillary lymph nodes 
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Analysis of the lymph nodes under the arm to see if they contain cancer cells helps doctors determine which treatment a woman may need after surgery. In the past, this procedure meant the removal of most of the underarm lymph nodes -- an operation called axillary dissection. We offer a conservative surgical procedure for many women who come to Memorial Sloan-Kettering for breast cancer care -- one that is easier to tolerate, speeds the recovery time, and enables women to return sooner to their normal day-to-day activities. Called sentinel node biopsy, this technique spares many women from a more extensive operation to remove nodes. This technique also saves many women from the most troublesome potential side effect of more extensive surgery -- lymphedema, or swelling of the arm.
With sentinel node biopsy, surgeons need to remove only one or a few lymph nodes for examination. If the cancer has spread beyond the original breast tumor, the "sentinel" node is where cancer cells would travel first, and it is identified by injecting a blue dye, a low dose of radioactivity, or both into the breast. Enhanced pathologic techniques are used to examine the sentinel node, allowing very small areas of cancer to be found. If this lymph node turns out to be free of cancer, the remaining nodes can be left intact, and no further surgery in the armpit is needed. If the sentinel node contains cancer cells, additional nodes are usually removed and analyzed.
Our extensive experience in performing sentinel node biopsy led our doctors to develop predictive models to identify which patients are most likely to have additional involved lymph nodes in advance of the results obtained by the biopsy.
Radiation Therapy
For women choosing lumpectomy, we are experienced in the use of intensity-modulated radiation therapy (IMRT) to the breast. During IMRT, a computer program is used to deliver[CS1] homogenous, uniform radiation to the whole breast, preventing the emergence of so-called hot spots (or areas that due to the shape of the tumor receive more radiation than others) and minimizing acute and late reactions. In addition, our ability to treat patients while they are lying on their stomachs (prone) enables us to better spare heart and lung tissue from the potentially harmful effects of radiation.
Through the collaboration of our plastic surgery team with our medical oncology group, we offer an integrated program of post-mastectomy radiation to women who have undergone immediate reconstruction and require radiation treatment. Our treatment algorithm has resulted in both excellent local control and a low rate of major radiation-related problems with reconstruction.
We also have an intraoperative radiation program, offering partial breast treatment to older women with very early breast cancer. Given at the time of the lumpectomy, this technology adds, on average, only 30 minutes to the time spent in the operating room and eliminates the need for postoperative radiation.
Innovative Reconstruction Techniques
For women who have had a mastectomy, our surgeons offer innovative reconstructive techniques. A major advance in breast reconstruction, pioneered at Memorial Sloan-Kettering, is called skin-sparing mastectomy. The surgeon removes the inner breast tissue and nipple, leaving a shell of skin in place; then the surgeon fills in the shell with tissue from the woman's abdomen and, later, reconstructs the nipple, resulting in a natural-looking breast. For a select group of patients requiring mastectomy, the nipple and areola may also be preserved, and when reconstructed with implants, this approach provides optimal aesthetic results.
Our plastic surgeons, in collaboration with the rest of the breast cancer team, can often perform reconstruction in patients who may need radiation therapy after reconstruction. We also have extensive experience with reconstruction for patients who have already had radiation therapy.
Advanced Imaging Technology
We offer digital mammography, a technique that enables radiologists to produce an image of the breast more quickly and to adjust the contrast of the image so that lesions can be seen more clearly. Breast imaging specialists at Memorial Sloan-Kettering refined and demonstrated the benefits of stereotactic needle biopsy, a procedure for diagnosing a suspicious area that can be seen on a mammogram, but is too small to be felt by touch. The procedure uses computer-imaging techniques to guide a needle into the breast to collect cells or tissue from a suspicious area observed on a mammogram. For many women, stereotactic needle biopsy can spare them from a more uncomfortable and expensive surgical biopsy. It may also enable doctors to make a diagnosis more quickly and allow women to start their treatment sooner.
We have integrated sophisticated imaging techniques, such as breast magnetic resonance imaging (MRI) and positron emission tomography (PET) scans, into our arsenal of tools for early detection, methods for obtaining tissue samples, and approaches to surgical treatment planning. Our radiologists are leaders in the field of breast imaging and continue to conduct research to further define the role of these advanced imaging techniques in the care of breast cancer patients.
Improvements in Systemic Therapy
Women who need systemic medical therapy (such as chemotherapy or hormonal therapy) benefit from Memorial Sloan-Kettering's expertise in these areas. We are a leading center for the development of innovative systemic therapies, including new biologic agents, hormonal approaches, and vaccines. Most of the effective systemic therapies developed in the past decade have been studied and explored by members of our medical oncology team.
For patients with early-stage breast cancer, Memorial Sloan-Kettering physicians pioneered dose-dense chemotherapy and led a national clinical trial that proved its benefits. They are also studying the use of individual drugs and combinations of drugs given on different treatment schedules to define the optimal approach that will provide patients with treatment that is more tolerable and effective for eradicating tumors.
Our physicians were instrumental in developing and proving the therapeutic role of paclitaxel (Taxol®). We conducted laboratory and clinical studies of therapies that use monoclonal antibodies such as trastuzumab (Herceptin®) and targeted molecular therapies such as lapatinib (Tykerb®), and translated these studies into clinically useful therapies for patients with both early and advanced disease. We are now studying a number of related drugs that kill cancer cells by disrupting their internal signaling pathways, and assessing their use in combination with each other and with conventional drugs used to treat breast cancer.
Our investigators have also developed ways to reduce the immune system suppression that often accompanies chemotherapy, which limits the dose of drugs that patients can receive. Immunological therapies (including breast cancer vaccines, which are designed to stimulate an immune response against cancer cells) are being developed and studied at our institution.
