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NCCN Guidelines for Patients


Breast Cancer - Early-Stage


, Version 1.2016


Breast cancer surgery

Lymph node surgery

Sentinel lymph node


A sentinel lymph node biopsy is

an option in two cases. It is an

option if no signs of cancer were

found in your lymph nodes by

physical exam and imaging tests.

It is also an option if no cancer

was found in FNA or core needle

biopsy samples. As explained

next, some women who have

a sentinel lymph node biopsy

will need an axillary lymph node


Axillary lymph node


An axillary lymph node

dissection is needed in four

cases. It is needed if after

neoadjuvant treatment, a

physical exam or imaging test

suggests there’s cancer in your

nodes. Second, it is needed if

cancer is found in FNA or core

needle biopsy samples and

you didn’t have neoadjuvant

treatment. Third, it is needed if

the sentinel lymph node wasn’t

found with the sentinel lymph

node biopsy. Last, it is needed

if cancer was found in your

sentinel nodes and there’s more

than a very small chance for the

cancer to return.


o find sentinel lymph nodes, a radioactive tracer, blue dye, or both

will be injected into your breast. The tracer and dye will drain into

lymph vessels within your breast and then travel to the breast’s lymph

nodes. Often, there is more than one sentinel node. After the dye

marks your sentinel node(s), it and likely some other nearby nodes

will be removed through a second cut near the breast.

An axillary lymph node dissection removes at least 10 lymph nodes

from Level I and II areas. Level I lymph nodes lie below the armpit.

Level II lymph nodes are in the armpit. If cancer is found in Level II

lymph nodes, nodes from Level III will be removed. Level III lymph

nodes are below the collarbone.

Side effects are more common and can be more complicated with

axillary lymph node dissection. Lymphedema is the most serious of

these side effects. Lymphedema is swelling due to buildup of lymph

and may not go away. Most women find lymphedema bothersome but

not disabling. There is no way to know who will have it or when it will

occur. Ask your treatment team for a full list of side effects caused by

lymph node surgery.

Figure 3.2 Lymph node surgeries

Sentinel lymph node


Axillary lymph node


sentinel nodes

Level I

Level II

Level III