Breastsaving operation with sentinel node procedure
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1. Injection of blue dye in the edge of the areola. The dye spreads by means of the lymfvessels to the first lymfnode in the armpit, the so called sentinel node. 2. After injection. The blue hyphen is the place where the tumour will be removed. Previously alsoo radioactive material has been injected at the areola or at the tumour, intended to trace the sentinel node. 3. The scan on which the area of injection of the radioactive material is seen, the lymfevessel and the gland (with the plussign)
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4. Tracing the lymfnode (that has been marked on the skin with a sign) with a probe. 5. Hereafter the blue coloured lymfvessel is searched for through a small incision.
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6. The lymfvessel is coloured blue by the dye. 7,8. This lymfvessel leads to the blue lymfnode wchich is checked for radioactivity.
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9,10. Once again the blue lymfvessel and the gland. 11. The armpit without all the fatty tissue and the lymfnodes (if it is necessary to remove all nodes in the armpit! That is the case when the sentinel node has been invaded by tumour. When the sentinel node contains no tumor cells, then the rest of the tissue in the armpit can be left in place). The result of the sentinel node can be assessed during the operation by frozen section research. However since there exists a considerable chance of error with that procedure, one may decide to wait for the definitive outcome of the sentinel node so that definitive operations may take place at at later stage. That means therefore an extra operation, but prevails a disappointment if a sentinel node that initially was said to be benign later proves to be malignant.
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12, 13. The armpit at the situation in which only the sentinel node has been removed. By means of a separate incision the tumour is removed. With clips (14, 15) the boundaries of the removed tissue in the breast are indicated so that the radiotherapist can see exactly where the tumour was located.
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17. The removed sentinel node in which the activity is, once more measured with the probe. 18. The situation after the breastsaving operation with the sentinel node procedure where all the tissue in the armpit has been removed. Skin abrogation is caused by the subcutaneous sutures and will disappear gradually. After the operation radiotherapy of the breast must be applied after several weeks. Treatment with medicines depends on the results of the tests of the lymfnodes and the nature of the malignant tumor. The blue discoloration of the skin can remain for a long time! The day after the operation the urine can have a green color as a result of the blue dye which is excreted by the kidneys. This is a temporary condition.