Lymph Node Biopsy

A lymph node biopsy is often a necessary procedure. With a diagnosis of Stage 1, 2, 3, or 4-breast cancer, your surgeon will want to look at one or more lymph nodes. There are many lymph nodes in your body.

You can look at the diagrams below to see an image of the lymph system and an image of the lymph nodes in your body.

The Lymph System

The lymph system consists of organs, ducts, and nodes. It carries lymph, a clear, watery fluid. The lymph fluid distributes immune cells called lymphocytes throughout the body. These lymphocytes protect the body against viruses and bacteria that invade the body.

There are two kinds of lymphocytes. The bone marrow produces them.

• T-lymphocytes (T-cells) mature in the thymus gland.
• ß-lymphocytes (ß-cells) mature in the bone marrow.

The main functions of the lymphatic system are:

• To collect and return lymph fluid to the blood
• To defend your body against disease by producing lymphocytes
• To absorb lipids from the intestine and carry them to the blood.

The lymph organs are:

• The bone marrow
• The lymph nodes
• The tonsils
• The spleen
• The thymus

The lymph nodes are small, bean shaped, soft nodules. They are a few millimeters to about 1 to 2 cm in their normal state. (1 inch = 2.54 cm) So, the lymph nodes are less than an inch in size.

As with the blood’s network of arteries and veins, the lymph channels form a network. But, unlike the blood, the lymph system is a one-way channel draining lymph fluid from the tissue. Then it returns the fluid to the blood.

The lymph node areas adjacent to the breast are:

• Axillary lymph nodes (under your arm)
• Supraclavicular lymph nodes (near your neck)
• Internal mammary lymph nodes (near the chest wall)

A lymph node biopsy is necessary to see if the cancer has spread from the milk ducts to the lymph nodes. The first cancer cells seen on a digital X-ray are in the milk ducts. They show up on a mammogram as clusters of microcrystallized calcifications. Doctors call it ductal carcinoma in situ (DCIS).

DCIS is also known as intraductal carcinoma. It is the most common type of non-invasive breast cancer. DCIS means that the cancer cells are inside the duct but have not spread through the walls of the duct cells into the surrounding breast tissue. It is contained in the ducts.

These cancer cells form in the ducts or in the milk lobes. It then spreads to the breast tissue near them. You can feel the tumors or the radiologist sees them with a mammogram. The severity or stage of the cancer depends on:

• The size of the tumor
• The microscopic evaluation of the cells
• The results of dissection of the lymph nodes

All of these factors will determine your treatment, especially the lymph node biopsy. Has the cancer invaded the lymph system? Has the cancer traveled to other parts of your body? Only the biopsy can answer those questions.

Your surgeon will make an incision in your armpit and remove most of the lymph tissue. A pathologist in a laboratory will examine the lymph nodes with a microscope.

A more recent technique is the sentinel node biopsy. This lymph node is the first one closest to your breast. Instead of cutting your armpit, your surgeon will remove just this one lymph node. Historically, if the sentinel node is positive for cancer cells, then the cancer has invaded your body. This surgery is easier than the axillary surgery.

You are worried. You are concerned. You are scared. You are anxious. All of this is normal. Radiation and chemotherapy can cure you. The five-year survival rate for Stage 1 cancer is 100%. 86% of patients with Stage 2 survive five years. And, 57% survive Stage 3.

Study of the lymph nodes is an important part of your diagnosis of breast cancer. Be sure your surgeon discusses all these options with you. Don’t be afraid to ask questions, and bring someone with you to your appointment.

Written by Margaret Stenerson-Reynolds
12 2  2009