Sentinel lymph node biopsies bring improved quality of life

Breast cancer patients on the Eastern Shore are now able to benefit from sentinel lymph node biopsies, a new capability at Riverside Shore Memorial Hospital.

 In January and February, surgeons Charles Goldstein, M.D. and Larry Weisner, M.D., conducted sentinel node biopsies for five breast cancer patients.  A 'sentinel' lymph node is the first lymph node to which cancer cells are most likely to spread from a primary tumor.  Sentinel lymph node biopsies are used to determine the extent of cancer in the body.

 Marshall Cross, M.D., a Riverside surgeon based on the Peninsula, proctored the procedure.

 "Through our affiliation with Riverside, we're now able to expand our scope of treatments, therapies and techniques and treat different diseases, and the Shore has benefited," Goldstein said.  This type of procedure is not commonly done in rural hospitals.

 How it works

 In breast cancer cases, sentinel lymph node biopsies are conducted at the same time a mastectomy or lumpectomy is performed.  A very low dose of a radioactive substance and a blue dye are injected at the site of the tumor.  The lymph node that absorbs the most of the blue dye and radioactive material is the first node in the chain of nodes throughout the body, or the 'sentinel' lymph node.  It is the most likely place cancer would be detected if it has spread.  The identified sentinel node is removed, and a pathologist checks it for cancer.

 If the sentinel node does not include cancer cells, then the cancer is not likely to have spread and removing additional nodes is unnecessary.  The patient benefits from a shorter, simpler surgery with a lower chance of long-term lymphedema which is swelling around the biopsy site.

Sentinel node biopsies are complex because they require a radiologist, nuclear medicine technician, pathologist and surgeon to coordinate.

 "There were a lot of hurdles to overcome logistically," Goldstein said.  "That's where Riverside Health System and Dr. Cross helped immensely.  This is not something that I could do myself.  It's such a team effort."

 A Riverside nuclear medicine technician from across the Bay came to the Shore to train the hospital's nuclear medicine technician.  Cross helped coordinate the procedure logistically and served as a mentor, or proctor, on site to oversee the flow and to make sure nurses understood the procedure and equipment and that Goldstein understood the technique and was competent to perform it.  Riverside Shore Memorial Hospital Administrator Susan McAndrews was also instrumental in coordinating.

 Being able to offer this surgery at Riverside Shore Memorial Hospital provides a huge service to patients, who might be scared or nervous due to the diagnosis and surgery, Goldstein said. Instead of having to travel for the procedure, it can be done close to home, making it easier on patients.

 "They don't have to go over an hour away.  Their support system is in place.  They're not in a strange environment," Goldstein said.  "Here on the Eastern Shore, it's a very close-knit community.  The patient's family is here.  Their friends are here.  It's got to help."

 "We offer a lot of services for a rural hospital – an internist, cardiologist, pulmonologist, urologist, ophthalmologist, gastroenterologist, orthopedic surgeon, two medical oncologists, a part-time ear, nose and throat surgeon.  Certainly a lot of rural hospitals our size do not have those subspecialties.  It's a bit unusual in how fortunate we are to be able to offer these services for a rural, community hospital," Goldstein said.

 Offering sentinel lymph node biopsies at Riverside Shore Memorial Hospital is one of the ways the affiliation with Riverside is expanding the hospital's services.  That will continue, especially with the construction of a new hospital, Goldstein said.  "More services and local access to them - that's the benefit of being affiliated with a larger system."

Published: March 18, 2013