Lymph node dissection and sentinel lymph node biopsy

Lymph node dissection and sentinel lymph node biopsy
These procedures are done specifically to look for cancer in the lymph nodes. These are
most often done after breast cancer is diagnosed, not as part of the initial breast biopsy.
They are described in more detail in the section, "How is breast cancer treated?"
Laboratory examination of breast cancer tissue
The biopsy samples of breast tissue are looked at in the lab to determine whether breast
cancer is present and if so, what type it is. Certain lab tests may be done that can help
determine how quickly a cancer is likely to grow and (to some extent) what treatments
are likely to be effective. Sometimes these tests aren’t done until the entire tumor is
removed by either breast-conserving surgery or mastectomy.
If a benign condition is diagnosed, you will need no further treatment. Still, it is
important to find out from your doctor if the benign condition places you at higher risk
for breast cancer in the future and what type of follow-up you might need.
If the diagnosis is cancer, there should be time for you to learn about the disease and to
discuss treatment options with your cancer care team, friends, and family. It is usually not
necessary to rush into treatment. You might want to get a second opinion before deciding
what treatment is best for you.
Type of breast cancer
The tissue removed during the biopsy (or during surgery) is first looked at under a
microscope to see if cancer is present and whether it is a carcinoma or some other type of
cancer (like a sarcoma). If there is enough tissue, the pathologist may be able to
determine if the cancer is in situ (not invasive) or invasive. The biopsy is also used to
determine the cancer's type, such as invasive ductal carcinoma or invasive lobular
carcinoma. The different types of breast cancer are defined in the section, "What is breast
cancer?"
With an FNA biopsy, not as many cells are removed and they often become separated
from the rest of the breast tissue, so it is often only possible to say that cancer cells are
present without being able to say if the cancer is in situ or invasive.
The most common types of breast cancer, invasive ductal and invasive lobular cancer,
generally are treated in the same way.
Breast cancer grade
A pathologist also assigns a grade to the cancer, which is based on how closely the
biopsy sample looks like normal breast tissue and how rapidly the cancer cells are
dividing. The grade can help predict a woman's prognosis. In general, a lower grade

number indicates a slower-growing cancer that is less likely to spread, while a higher
number indicates a faster-growing cancer that is more likely to spread. The tumor grade
is one factor in deciding if further treatment is needed after surgery.
Histologic tumor grade (sometimes called the Bloom-Richardson grade, Nottingham
grade, Scarff-Bloom-Richardson grade, or Elston-Ellis grade) is based on the
arrangement of the cells in relation to each other: whether they form tubules; how closely
they resemble normal breast cells (nuclear grade); and how many of the cancer cells are
in the process of dividing (mitotic count). This system of grading is used for invasive
cancers but not for in situ cancers.
· Grade 1 (well differentiated) cancers have relatively normal-looking cells that do not
appear to be growing rapidly and are arranged in small tubules.
· Grade 2 (moderately differentiated) cancers have features between grades 1 and 3.
· Grade 3 (poorly differentiated) cancers, the highest grade, lack normal features and
tend to grow and spread more aggressively.