Angelina Jolie's Innovative Approach to SNB

This is standard in Europe

Lily and apc - this is different from the standard dye injection and immediate node biopsy.

The approach allows the surgeon to identify the sentinel node and NOT remove it until it is certain from subsequent pathology that there is invasive cancer present.

This is not to be used for women who are known already to have invasive cancer, but for women who may or may not have it, such as women with LCIS, DCIS, BRCA mutation or widespread atypia who have elected to do a mastectomy. 

It's great!

Its true its standard in Europe. Along with the ink there is a radioactive agent which can be traced. The majority of the breast is drained to the axillary region as "first stop". They use a tracer which identify where the first lymphnode is located. They take this one out - some places its rushed to pathology - and if further surgery is needed it can be done right away. Mine was just taken out and sent to normal pathology because I had neoadjuvant chemo and would need surgery anyway later on... So there was plenty of time to find out if I needed ALND.

new_direction, what you are describing is standard here in the US and it is the procedure to find the sentinel node.

What AJ had was a bit different.  In cases where a woman does not have known invasive cancer but does have an abnormality, she frequently has to make a choice about sentinel node removal while having mastectomy.  It is a very tough choice because chances are,  you will not find invasive and will have removed the node(s) unnecessarily which means elevated chance of lymphedema, a lifetime of protective requirements. 

However if the same patient elects to forego the sentinel node biopsy and unexpected cancer is found, then she has a big problem because she likely will need auxillary dissection which is an even bigger procedure. 

AJs technique solves the problem very nicely and would make a huge difference for a certain, unique patient population.

I had the impression from reading the procedure blog that this would be a separate surgery (if needed) at a later date, subsequent to the path of the breast tissue.

It's certainly at an investigational stage and they don't know how long dye will last.  It seems not too difficult to create a dye additive that might dwell longer in the node than it does now, but that is just a guess on my part.

I thought it was one of the most exciting things about AJs story.  I never heard of this idea. 

When I had bilateral mx, I actually asked if we could "mark" my sentinel node, like with a titanium clip or something, so we would know where it was if we needed it later.  My surgeon told me this would do little good as once we cut into the lymphatics, the risk will exist.  Ultimately I did the surgery without sentinel node removal.  I got lucky and we didn't find invasive but it was a big worry.  AJ's procedure would really help  people in the same position!

Hi FarmerLucy!  I remember your story.  How did they identify the sentinel after your MX?

"Not so long ago, the Mass General group got an article published arguing that the LE risk from SNB was so low, at their institution, that it should be done in all prophylactic mastectomies. "

What hubris!!  Even if there was low risk, it does not exempt the patient from the required preventative strategies, e.g. blood pressure cuffs, blood draws etc, which would be unnecessary if the SNB were not done.  In the case of bilateral MX, this is a significant lifetime burden. 

Plus, we know plenty of women who do get LE from SNB alone. 

beacon thanks for explaining that.
Lovely flowers by the way

PS. To Beacon800's doc's concern: the clips are pretty tiny. I know they place them when you have a core biopsy so they can apparently be placed thru a needle which wouldn't cut into the lymphatics much.

I had my surgery yesterday(lumpectomy left breast)..I had nuclear medicine sentinel node dye injection 3hours before surgery....we feel very encouraged that (this is where it get foggy,surgeon had said he would take three node) surgeon told family that the tumor was large and that two nodes were clear....so did he take only two or did he take three...we 'll find out everything on Thursday next. My diagnosis was IDLC. Left breast...RT breast jwire procedure was done. I don't think we know anything about that yet....I have to be honest..the dye injection to the tumor area was the most painful thing ever in my life. Far worse than kidney stones or giving birth.... They couldn't deaden the areas to be injected with the dye. 4 injections of dye lasting about 20 seconds each. I was literally and shamefully screaming..louder with each injection... I keep looking on this site for someone who has had this procedure this same way. .anyone

Dear sarajaneevans,

Reacting to pain and discharging your emotions is nothing to be ashamed of, in my eyes.  I think screaming or crying when in pain is a way to process it and helps in the recovery.  But I am so sorry you went through that.  Sending you healing thoughts... May you find comfort and peace in connecting with everything good around you.  As I tell my son, let out the sad and the mad, to make room for the glad. 

Thanks for the response kayb-I didn't know this-  I am still not as clear as I would like to b e regarding the lymph/sentinel nodes..hopefully after tomorrows appontment I will have a more clear understanding..I am making a list of questions to ask from the responses posted here... I usually have a high pain tolerance, but not in the case of this procedure...BIG OUCH

@Fearlessfoot-thanks for the response-at the moment I was going through it, I decided if I didn't scream with it the whole procedure would go very badly-so for the first time in my life I went with it, so to speak- I am curious why it is so painful for some and not so much for others.. once the procedure is completed the pain disssipates with no lingering effects except the memory of how painful it was, so that is a good thing..

I am constantly in awe of the numbers of woman on this site, the courage and persistence of each and every one- you are all true warriors..

I, too, found the dye injection the most painful part of the whole thing. Actually, the most painful event of my whole life. I am dreading doing it again. I didn't scream (I'm not a screamer) but my poor husband almost lost fingers I squeezed so tight!  I'll try to remind him to take off his wedding ring before he gives me his hand this time! LOL.