Sentinel node biopsy

1. Position the patient supine.
2. Following induction of anaesthesia, inject 1ml of undiluted patent blue V dye in a peri-tumoural (or sub-areolar for an impalpable lesion) manner after informing the anesthetist. Massage the area for 3 minutes.
3. Locate the maximum area of radioactivity prior to making an incision over the site in the axilla with a gamma probe.
4. Use diathermy to dissect down to the level of axillary fat. Identify blue lymphatics and follow them to the sentinel node while intermittently confirming its position with the gamma probe. Haemostasis is essential.
5. Excise the node once found and record the radioactivity count for a 10 second period. Re-test the axilla for further radioactivity. If there is a suspicion of further radioactive nodes, follow and excise them. Take a background count once complete.
6. Close the axillary wound in two layers.