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The direction of lymph flow in the breast tissue is largely towards the axillary lymph nodes. For this reason, cancer cells that spread usually first go to the axillary lymph nodes. Knowing the status of axillary lymph nodes in breast cancer patients is important in diagnosis, treatment and follow-up: Blue dye (isosulfan blue or methylene blue) alone or in combination with a radioactive substance is injected into the tumour area or under the nipple. The dye reaches the first (sentinel) lymph node in the armpit within 5-7 minutes. The number of sentinel lymph nodes can be more than one; the average is 2. These lymph nodes are removed and investigated whether they contain tumour cells. If no tumour cells are seen, the procedure is terminated; other lymph nodes in the armpit do not need to be removed.
In patients with lymph node involvement, removal of the axillary lymph nodes is required and this provides local tumour control.
