Some GP surgeries in the UK now have adequate resources and skills to perform this minor procedure in the community. Incision and drainage with appropriate wound management remains the mainstay of treatment for subcutaneous abscesses. Most are caused by bacterial infections, most commonly by skin flora. Usual sites include the perianal region, axilla, breast and groin. Subcutaneous abscesses are common presenting symptoms at most general practitioners (GPs), accident and emergency departments, and surgical consultations. She underwent radical chemotherapy and is currently in remission. Biopsies revealed primary breast lymphoma (B-cell). The patient underwent wound debridement, washout and application of negative pressure vacuum therapy. There was no history of breast symptoms prior to the onset of the axillary abscess. Two months after the incision and drainage, and after regular wound dressing, the patient was referred to the acute surgical team with a complicated, non-healing right axillary abscess cavity and associated generalised right breast cellulitis. The practice nurse subsequently oversaw the follow-up care of the wound. This prompted her GP to perform an incision and drainage procedure of the abscess. Despite antibiotics, the patient's symptoms worsened and the abscess increased in size. A diagnosis of folliculitis was made and the GP started a course of flucloxacillin. A false-negative biopsy result is possible – the doctor and patient are misled into thinking the cancer cells have not spread to nearby nodes.A 67-year-old woman with non-insulin dependent diabetes mellitus with a history consistent with a right axillary abscess, presented to her general practitioner (GP).The skin of the breast could also turn blue, but this fades away with time. The use of the blue dye to find the sentinel node could turn the urine a blue-green colour for 24 hours after surgery.There is a small risk of skin/allergic reactions to the blue dye test or radioactive fluid.There is a low risk of shoulder stiffness, numbness in the arm, shoulder, underarm and parts of the chest seroma (fluid collecting near the surgical scar) lymphoedema in the arm (built up of lymph fluid) causing swelling, pain or discomfort.Potential side effects of a sentinel node biopsy include: What are the possible side effects of sentinel node biopsy? If no cancer cells are detected, the additional removal of lymph nodes will not be required. If cancer is present, the surgeon will remove additional lymph nodes. What happens after a sentinel node biopsy?Īfter the sentinel node biopsy, a pathologist checks the sentinel node for cancerous cells. With the use of a hand-held probe (a highly directional Geiger counter) that detects the radioactive substance together with the blue appearance of the sentinel node, the surgeon is guided to the correct node(s) where a small incision in the skin is made to remove the node (or nodes). The blue dye also flows through the lymphatic vessels to the draining lymph nodes of the cancer. Lymphoscintigraphy is used to find the sentinel lymph node (or nodes). The radioactive fluid flows to the sentinel nodes through the lymphatic vessels and can be seen on a nuclear medicine scan (lymphoscintigram). To help locate the sentinel node, the patient is injected with a small amount of a low-grade radioactive fluid and/or blue dye in the breast around the cancer or under the nipple area. How is a sentinel node biopsy performed?Ī sentinel node biopsy involves mapping the location of the node (or nodes) either before or during a biopsy or mastectomy procedure. Typically, people have one sentinel node, but it’s possible to have two or three. Generally, the sentinel node is located in the underarm (axilla), however it can also be found in other parts of the body, such as in the chest between the ribs under the breast or above or underneath the collarbone. Lymph nodes are located all over your body, including your underarms, groin, neck, the area around the lungs and the gut.Ī sentinel lymph node is the first lymph node to where cancer cells may spread outside of the primary tumour site (such as the breast). They filter lymph fluid to remove harmful substances (such as bacteria, viruses and abnormal cells such as cancer cells) and return the ‘clean’ fluid back to the bloodstream.Īs such, they are vital for fighting infections. Lymph nodes are small, rounded masses of lymphatic tissue located along the lymph vessel. Lymph nodes are part of the lymphatic system, which make up part of the body’s immune system. Sentinel Lymph Nodes Biopsy Sentinel Lymph Nodes
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