Procedure reduces pain and discomfort in breast cancer patients

VCU Massey Cancer Center’s surgical oncologists are the only breast cancer surgeons in the region to offer a procedure that greatly reduces pain accompanied with sentinel node biopsies.

The lymphatic system helps to rid the body of toxins and is a key component of the immune system, but it can also assist in the spread of breast cancer by transporting cancerous cells. The first lymph nodes that could potentially take in cancerous cells and spread them throughout the body are called the sentinel nodes. Doctors use a minimally invasive procedure known as a sentinel node biopsy to find sentinel nodes and remove tissue from them so that the tissue can be examined in order to determine whether the cancer has spread outside of the original tumor.

Dr. Vu

In standard practice, patients are given injections of radiocolloid, a slightly radioactive blue dye used to identify the sentinel node, into the breast up to several hours before surgery. Even with the use of local anesthesia, there is significant discomfort and pain associated with the injections. Huan Vu, M.D., a surgical oncologist at VCU Massey Cancer Center, witnessed this discomfort in his patients and wanted to find a better way.

In a study of over 750 patients conducted between 2005 and 2010, Vu and other surgical oncologists at VCU Massey Cancer Center examined whether injecting radiocolloid in patients under general anesthesia during a surgical biopsy was as reliable in identifying the sentinel lymph nodes as injecting radiocolloid preoperatively, or before surgery. The results of the study showed that giving the injections after patients had been given general anesthesia was just as effective as preoperative injections.

When performing sentinel node biopsies, doctors are concerned with identifying the sentinel node, verifying whether cancerous cells are present and determining the stage, or extent to which the cancer has spread. Vu and his colleagues saw no difference in any of these aspects between the two groups of patients. In addition, giving the radiocolloid injections during surgery was just as effective in determining which patients needed to undergo a procedure known as axillary dissection to examine the lymph nodes under a patient’s armpit.

“Breast cancer patients have to endure enough pain and discomfort in their treatments and tests. As their doctor, I will do whatever I can to make them as comfortable as possible as long as it does not compromise their outcome,” says Vu. “Thanks to the results of this study, I now perform all of my sentinel node biopsies in this fashion and my Massey colleagues offer this option to their patients as well.”

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Dr. Vu Graph of results

Sentinel Node Biopsy: Preoperative vs. Intraoperative Injection