Lumpectomy with Sentinel Lymph Node Biopsy

Procedure Snapshot

• Indication: Early-stage breast cancer (Breast-conserving therapy).
• Expected duration: ___
• Special instruments: Gamma probe, blue dye, electrocautery.

Step Workflow

1. Inject tracer (peritumoral or periareolar).
2. Make incision over tumor; excise with 1-cm margins.
3. Send specimen for orientation and margins.
4. Separate axillary incision; identify blue/hot nodes → excise.
5. Place clips and close dead space.

Key Pimp Questions

• Q: What if > 2 positive nodes? A: ALND unless Z0011 criteria met (PMID 21388309).
• Q: False-negative rate? ___ (PMID 32700504).

Critical Anatomy

• Landmarks: Axillary vein, pectoral fascia.
• Danger zones: Long thoracic nerve.

Informed Consent Highlights

• Bleeding, seroma, lymphedema, re-excision if positive margins.

Post-op Considerations

• Pressure dressing; ROM day 1.

References

• Chassin’s, Breast surgery. Clinical Scenarios, Breast chapter.
• Giuliano 2011 (PMID 21388309).