Axillary Lymph Node Biopsy in Ankara, Turkey

An axillary lymph node biopsy is a procedure primarily performed in patients diagnosed with breast cancer to determine whether the cancer has spread to the lymph nodes. This biopsy is important for staging the disease and clarifying the treatment plan.

Fine-needle aspiration biopsy, tru-cut (core needle) biopsy, and sentinel lymph node biopsy are among the most commonly preferred methods. The choice of method depends on the number, size, and location of suspicious lymph nodes.

The procedure is usually performed under local anesthesia with ultrasound guidance. After the biopsy, short-term pain, bruising, or swelling may occur. The risk of the procedure is low and it is generally well tolerated without disrupting daily life.

The result of an axillary lymph node biopsy is decisive in guiding additional treatments such as surgical extent, radiotherapy, or chemotherapy based on the degree of cancer spread. Early evaluation improves treatment success.

You can contact Prof. Dr. Ebru Soy, one of the doctors performing Axillary Lymph Node Biopsy in Ankara, to get information about Axillary Lymph Node Biopsy prices, the process, and the hospital where Axillary Lymph Node Biopsy is performed.

What Is an Axillary Lymph Node Biopsy?

An axillary lymph node biopsy is a procedure performed to evaluate enlarged or suspicious lymph nodes in this region for diagnostic purposes. It is commonly used to determine the cause of conditions such as infection, immune system diseases, or cancer. The tissue sample obtained is evaluated pathologically to analyze cellular changes within the lymph node. The procedure can be performed via needle biopsy or surgical methods.

Why Are Axillary Lymph Nodes So Important in Breast Cancer?

The lymph fluid circulating in our body is one of the most important parts of the immune system, and the stations where this fluid is filtered are called lymph nodes. Due to anatomical structure, the lymph fluid of the breast largely drains toward the armpit (axilla). When breast cancer has the tendency to spread rather than remain localized, the first route it usually follows is through these lymphatic channels. When cancer cells leave the breast and begin their journey, their first stop is often these lymph stations in the axilla. Therefore, the axilla is the most critical indicator for us to determine whether the disease has spread throughout the body.

The pathological status of the lymph nodes—whether they contain cancer cells—allows us to determine the stage of the disease. If there is no involvement in these nodes, we can say the disease has remained localized and was caught at an early stage. However, if involvement is present, this indicates that the disease has the potential to become systemic. This information shapes our roadmap after surgery. Based on this alone, we decide whether you will receive chemotherapy, which drugs to choose if you do, the duration of hormone therapy, and whether radiation therapy should be applied to the axillary region.

In the past, to understand lymph node status, we routinely performed operations called “Axillary Lymph Node Dissection” (ALND), where all nodes in the axilla were removed. Although this provided disease control, it could cause serious long-term problems such as arm swelling, pain, and restricted movement. Today, our core philosophy has changed. We now know that systemic therapies (chemotherapy and targeted agents) and radiotherapy are very successful in eliminating microscopic disease. Therefore, if it is oncologically safe, our goal is to achieve the same success with less tissue removal and less surgical trauma.

What Is Sentinel Lymph Node Biopsy (SLNB)?

The biggest shift in our medical approach began with abandoning the unnecessary removal of all lymph nodes. Removing all nodes could cause lifelong problems such as arm swelling, pain, and limited mobility. This is where the “Sentinel Lymph Node Biopsy” (SLNB)—a revolutionary concept in surgical oncology—comes into play. To understand this method, we can use the analogy of a security checkpoint.

There are one or a few lymph nodes that first receive lymph fluid leaving the breast tumor as it reaches the axilla. We call these the “sentinel” nodes. Logically, if cancer cells are going to spread from the breast to the axilla, they must first pass through these gatekeeper nodes. If there is no cancer in this first station, we can assume with high confidence that the dozens of nodes behind them are also clear.

In this procedure, our goal is to locate and remove only these few nodes during surgery using special techniques. These nodes are examined by a pathologist while the operation continues. If the result is negative, we do not touch the rest of the axilla. In this way, we preserve lymph circulation, protect nerves, and speed up recovery. Studies have proven that in properly selected patients, this method is as safe as removing all nodes, but far superior in terms of quality of life.

Candidates who are suitable for this procedure include:

• Patients diagnosed with early-stage breast cancer
• Those with no palpable axillary mass on clinical examination
• Those with no suspicious lymph node on ultrasonography

Which Mapping (Dye/Tracer) Methods Are Used to Find the Sentinel Node?

Finding the sentinel lymph node is not like searching for a needle in a haystack because we have highly advanced technologies. Since these nodes are hidden within normal fatty tissue, it is difficult to distinguish them with the naked eye. The surgeon needs “mapping” techniques to locate them accurately. The aim is to avoid false-negative results—meaning the risk of missing cancer when it is actually present. Successful surgery is measured by a high identification rate and a low error margin.

For this reason, we often prefer the dual modality mapping approach. Using two different methods simultaneously increases accuracy because what one might miss the other can detect, bringing success rates close to 100%.

The main tracers used include:

• Blue dye
• Radioisotopes
• Indocyanine green
• Magnetic tracers

With the blue dye method, we inject a special dye into the breast tissue at the start of surgery. The dye travels through the lymphatic channels and stains the first node blue, allowing us to follow the colored pathway. With the radioisotope method, a very low dose of a radioactive substance is administered before surgery. During the operation, a device called a gamma probe gives an audible signal as we approach the node where the tracer has accumulated. Indocyanine green (ICG), which has become more popular in recent years, is a fluorescent tracer and, when viewed with special cameras, shows the lymphatic pathways as a glowing green line. In settings without a nuclear medicine unit, magnetic tracers (iron oxide particles) can be used and the node can be detected with a metal-detector-like probe.

How Does the Process Work in Patients Who Receive Chemotherapy Before Surgery?

In breast cancer treatment, the sequence is not always “surgery first, then medication.” In some cases—especially if the tumor is large or the biological subtype is aggressive (for example Triple-Negative or HER2-Positive)—we prefer to start treatment with chemotherapy. This is called “Neoadjuvant Chemotherapy” (NACT). The aim is both to shrink the tumor in the breast to increase the chance of breast-conserving surgery and to eradicate cancer cells in the axilla if spread has already occurred.

However, this makes surgical planning a bit more complex. If we detected a cancer-positive axillary lymph node at the initial presentation and then administered chemotherapy, on the day of surgery we ask: “Has that cancer-positive node completely responded?” Chemotherapy can cause structural changes in lymphatic tissues, fibrosis (hardening), and disruption of lymphatic flow pathways. This can reduce the reliability of standard sentinel lymph node biopsy.

After chemotherapy, searching only for sentinel nodes with standard methods increases the risk of a false-negative result. In other words, we may miss a node still harboring cancer cells because it does not take up dye or because lymphatic flow has changed. This risk can exceed acceptable safety thresholds. Therefore, in patients with axillary involvement who receive preoperative chemotherapy, we need to apply a more specific and advanced technique.

What Is Targeted Axillary Dissection (TAD)?

Targeted Axillary Dissection (TAD) is one of the most rational solutions in modern surgical oncology. It was developed to eliminate the uncertainty that may occur after chemotherapy. The logic is simple: “Mark the enemy in advance, then go and find it.”

The process works as follows: Before chemotherapy begins, we biopsy the lymph node that we have proven to be cancer-positive under ultrasound guidance and place a small “clip” (marker) inside it. This marker can be a metallic clip, a magnetic seed, or a radioactive seed. After that, the patient receives chemotherapy; months pass; the tumors shrink or disappear. On the day of surgery, we, as surgeons, look for two targets at the same time.

First, the nodes found with standard sentinel node techniques (dye or isotope). Second—and more importantly—the node carrying the clip that was placed months earlier. We track the signal from that clip using special devices and remove that specific node. In this way, we can clearly see how the “guilty” node—known to be involved at the start—responded to treatment.

With TAD, false-negative rates can drop to very low levels such as 2% to 6%. If the marked node and the other sentinel nodes are negative (meaning chemotherapy has completely eradicated cancer), we can spare the patient from having all axillary nodes removed. This method ensures oncologic safety while maximizing quality of life.

In Which Situations Is Complete Axillary Lymph Node Dissection (ALND) Necessary?

Although the overall trend in surgery is toward de-escalation—preserving tissue and minimizing procedures—there are situations where a more comprehensive clearance becomes mandatory for long-term safety and to reduce recurrence risk. Axillary Lymph Node Dissection (ALND), which involves removing level I and II lymph nodes in the axilla, is no longer routine and is used only when specific criteria are met.

The goal is to reduce the risk of leaving cancer behind to zero. Especially when the disease burden is high, doing less surgery can put the patient at risk. Therefore, when your surgeon makes this decision, it is entirely focused on your long-term health.

Situations that may require ALND include:

• Patients with persistent cancer cells despite neoadjuvant chemotherapy
• Those diagnosed with inflammatory breast cancer
• Patients with cancer found in 3 or more sentinel lymph nodes
• Cases where axillary disease has recurred
• Situations where the sentinel lymph node cannot be identified due to technical reasons

Why Is Nerve Preservation Critical in Axillary Surgery?

The axillary region is one of the most complex and delicate crossroads in the body from a surgical perspective. It is not only composed of fat and lymph nodes; vital nerve networks and major vessels that control the movement of the arm, shoulder, and back muscles pass through this area. A surgeon’s skill is measured not only by removing diseased tissue but also by preserving these sensitive structures with meticulous precision.

During a full axillary dissection (ALND), there are very important nerves that must be protected. The first is the “Long Thoracic Nerve.” If this nerve is injured, the shoulder blade cannot stay in place and protrudes outward (winged scapula). This can make it difficult or impossible to lift the arm above the head, comb hair, or reach a high shelf. The second critical structure is the “Thoracodorsal Nerve,” which powers the latissimus dorsi muscle and supports pulling strength of the arm.

Another nerve that greatly affects comfort is the “Intercostobrachial Nerve,” which carries sensation from the inner upper arm. In the past, this nerve was often cut, and patients experienced long-term numbness, tingling, or burning on the inner arm. Today, with nerve-sparing surgical techniques, we carefully identify and preserve this sensory nerve whenever possible.

Critical structures to protect include:

• Long thoracic nerve
• Thoracodorsal nerve
• Intercostobrachial sensory nerve
• Axillary vascular structures

What Can Be Done to Reduce the Risk of Lymphedema (Arm Swelling)?

One of the biggest concerns for patients undergoing breast cancer surgery—after cancer itself—is the fear of “Will my arm swell?” Lymphedema occurs when the return pathway of lymph fluid is disrupted after lymph nodes are removed, causing fluid to accumulate in the tissues and the arm to swell. This is not only a cosmetic issue but also a chronic health problem that can cause heaviness, pain, and increased susceptibility to infections.

Our primary strategy in managing lymphedema risk is to keep surgery as limited as possible. That is why Sentinel Lymph Node Biopsy (SLNB) and Targeted Axillary Dissection (TAD) are so valuable. Large studies show that lymphedema risk is significantly higher when all axillary nodes are removed, whereas it remains very low when only sentinel nodes are excised.

We also aim to reduce risk with surgical technique. Preserving blood vessels that run alongside lymphatic channels and, when needed, using microsurgical methods to support lymph flow can be part of this strategy. However, patient-related factors also matter. Obesity is an independent risk factor that increases lymphedema risk. In addition, receiving radiotherapy to the axilla after surgery can also increase the risk to some extent.

Factors that increase lymphedema risk include:

• Removal of a high number of lymph nodes
• High body mass index (Obesity)
• Radiotherapy applied to the axillary region
• Postoperative infection

How Can Seroma Formation After Surgery Be Prevented?

The most common early postoperative issue is “seroma,” which means fluid collection. When we remove lymph nodes and fatty tissue in the axilla, a space (dead space) forms under the skin. The body naturally tries to fill this space with tissue fluid as part of healing. Patients often describe it as feeling like a water balloon or carrying a small ball in the armpit.

To prevent seroma, we take technical precautions during surgery. The most effective method is to close the dead space by suturing the skin flaps down to the underlying muscle—this is called the “quilting” technique. If there is no space for fluid to collect, seroma becomes less likely. We may also place thin tubes called “drains” to remove accumulating fluid, which speeds healing.

Drains are typically removed once fluid output decreases—often within about a week. If seroma develops, it is usually not a cause for alarm; it can be drained in the clinic with a simple needle aspiration and rarely causes a permanent problem.

Which Patients Do Not Need Axillary Biopsy?

Modern medicine increasingly focuses on the question: “For whom can we do less?” We now know that in some patient groups, the information we would gain from axillary surgery does not change the treatment plan. In particular, results from an important clinical trial called “SOUND” suggest that axillary surgery may be omitted entirely in selected patients who meet certain criteria.

For example, in older patients with very small tumors, no suspicious axillary findings on ultrasound, and favorable tumor biology (hormone receptor-positive, HER2-negative), we may skip even sentinel lymph node biopsy. This is because even if there is microscopic nodal involvement, endocrine therapy and breast radiotherapy are often sufficient to control the disease. In this way, we can spare the patient from an unnecessary procedure and its potential side effects.

Situations where axillary surgery may be omitted include:

• Patients with small tumors and no axillary involvement on ultrasound
• Patients aged 70 or older with hormone-sensitive breast cancer
• Appropriate candidates planned for breast-conserving surgery and radiotherapy

Frequently Asked Questions

When is an axillary lymph node biopsy performed?

This biopsy is usually performed in patients diagnosed with breast cancer to evaluate whether the cancer has spread to the lymph nodes. It may also be used when infection, lymphoma, or other malignancy is suspected.

Will arm movements be restricted after an axillary lymph node biopsy?

Light arm movements are usually possible after the procedure. However, heavy lifting should be avoided for a few days. If a surgical biopsy was performed, the exercises recommended by the physician should be done to fully restore arm mobility.

Can an axillary lymph node biopsy be done under local anesthesia?

Yes, most axillary lymph node biopsies can be performed under local anesthesia. Depending on the depth or size of the lymph node, sedation or general anesthesia may be preferred.

Is swelling normal after an axillary lymph node biopsy?

Yes, mild swelling and bruising in the area are normal and usually decrease within a few days. However, if swelling increases or redness develops, evaluation is needed due to possible infection risk.

How long does it take to get axillary lymph node biopsy results?

Pathology results are typically available within 5–7 business days. The time may vary depending on the biopsy type, laboratory workload, and the amount of tissue requiring analysis.

Does lymphedema develop after an axillary lymph node biopsy?

If only a single lymph node is removed via biopsy, the risk of lymphedema is quite low. However, the risk increases if multiple lymph nodes are removed or if radiotherapy is added.

Is there a risk of infection after an axillary lymph node biopsy?

Yes, as with any invasive procedure, there is a risk of infection, but it is rare. You should consult a physician if there is redness, increased warmth, discharge, or worsening pain.

Why is an axillary lymph node biopsy performed besides cancer diagnosis?

Biopsy is used not only for cancer diagnosis but also for diagnosing infectious or inflammatory diseases such as tuberculosis and sarcoidosis. The size of the lymph node and accompanying findings affect decision-making.

How long does pain last after an axillary lymph node biopsy?

Mild pain and discomfort may continue for a few days. It is usually controlled with simple pain relievers. Severe or prolonged pain may require evaluation.

If the biopsy result is negative, are further tests needed?

If pathology is negative, additional procedures are usually not required. However, if clinical suspicion remains or imaging findings are discordant, further testing or follow-up may be recommended.

How Long Does an Axillary Lymph Node Biopsy Take?

An axillary lymph node biopsy usually takes between 30 minutes and 1 hour. The duration may vary depending on the type of procedure (needle biopsy, open surgical biopsy, or sentinel lymph node biopsy).

Which Doctor Should You See for an Axillary Lymph Node Biopsy?

A general surgeon is the specialist you should consult for this procedure. After the necessary evaluations, the surgeon performs the biopsy.

How is an axillary lymph node biopsy performed?

An axillary lymph node biopsy is the procedure of taking a tissue sample from a suspicious lymph node. It is most commonly performed under ultrasound guidance as a fine-needle biopsy or a core needle (tru-cut) biopsy. The procedure is usually done under local anesthesia and is completed in a short time. In rare cases, a surgical biopsy may be necessary.

When is an axillary lymph node dangerous?

A lymph node that is hard, painless, rapidly growing, and does not shrink over time is considered suspicious. If it is accompanied by systemic symptoms such as weight loss, night sweats, or fatigue, further evaluation is required.

What does axillary lymph node swelling mean?

Axillary lymph node swelling most commonly occurs due to infections. Painful and temporary swelling is usually benign. However, swelling that persists, grows, or feels hard requires medical evaluation.

Why do axillary lymph nodes swell?

Lymph nodes can enlarge due to infections, inflammation, skin wounds, or immune responses. Rarely, breast diseases or certain cancers can also cause swelling in axillary lymph nodes.

Is axillary lymph node swelling dangerous?

Most lymph node swelling is harmless and shrinks on its own over time. However, hard, fixed, painless swellings lasting longer than 3–4 weeks may be due to more serious causes. In such cases, medical evaluation is important.

What happens if axillary lymph nodes are removed?

After lymph nodes are removed, there is a risk of lymphedema (swelling) in the affected arm. Susceptibility to infections may also increase. Therefore, lymph node removal is performed only when necessary and with careful surgical planning.