Axillary Node Biopsy is a surgical procedure aimed at sampling a single or group of lymph nodes in the axilla (armpit) to determine the diagnosis. When performed in the context of breast cancer, it is planned in conjunction with the cancer surgery to assess the extent of the disease and aid in treatment planning.

Why is it Done?

Axillary node biopsy is performed for several reasons:

• Diagnostic purposes: Removal of the enlarged/target node and subsequent pathology testing helps ascertain the diagnosis and aids in further workup and treatment planning.

• Staging of cancer: By examining lymph nodes for the presence of cancer cells, clinicians can determine the stage of breast cancer, which influences treatment decisions and prognosis.

• Treatment Planning: The results of axillary node biopsy help oncologists tailor treatment strategies, such as surgery, chemotherapy, radiation therapy or targeted therapy, to effectively combat the disease.

• Prognostic Information: Lymph node status serves as a prognostic indicator, providing valuable insight into the likelihood of disease recurrence and overall survival.

Procedure and Techniques:

Axillary node biopsy can be performed using various techniques, including:

• Single Node biopsy: A small incision is made in the axillary crease along the lower hairline. Careful dissection is done to identify the target/enlarged lymph node and it is removed and sent for pathological analysis.

• Sentinel Lymph Node Biopsy (SLNB) or Low Axillary Sampling (LAS): This minimally invasive procedure involves identifying and removing the first nodes to receive drainage from the breast tumor. This procedure reduces the risk of complications or sequelae associated with traditional lymph node dissection while providing accurate staging information.

• Targeted Axillary Dissection: Recent advances in imaging techniques and molecular profiling allow for targeted axillary dissection, where only specific lymph nodes suspicious for metastatic involvement are removed, minimizing surgical morbidity while maintaining diagnostic accuracy.

• Axillary Lymph Node Dissection (ALND): In cases where node sampling indicates lymph node involvement or when more extensive lymph node evaluation is warranted, ALND may be performed. This involves removing a greater number of lymph nodes from the entire axilla for pathological examination.

• Extended Axillary Lymph Node Dissection: Sometimes, lymph nodes from areas in the vicinity of the axilla maybe included for adequate clearance.

Benefits of Axillary Node Biopsy:

The benefits of axillary node biopsy include:

• Accurate Diagnosis: Providing the entire lymph node for histopathological testing helps in diagnostic evaluation and provides adequate material for further tests if required.

• Appropriate Staging: By identifying whether cancer has spread to the lymph nodes, clinicians can accurately stage the disease, facilitating appropriate treatment planning.

• Personalized Treatment: Knowledge of lymph node involvement allows for personalized treatment approaches tailored to each patient's specific condition, improving therapeutic outcomes.

• Reduced Morbidity: It is a less invasive procedure associated with reduced post procedure morbidity and shorter recovery times.

• Prognostic Value: Lymph node status provides valuable prognostic information, guiding long-term follow-up and management strategies.

Axillary node biopsy aids in the diagnosis of a target node. In breast cancer, it plays a crucial role in providing valuable information for staging, treatment planning and prognostication.