Sentinel Node Biopsy

[Billington]

I don't typically have these types of cases, some help would be nice.

The patient is a 59-year old female with a history of a known left breast cancer. She has undergone wire localization as well as preoperative lymphatic mapping.

The patient was brought to the operating room and placed supine on the operating room table. After initiation of anesthesia 5cc of Lymphazurin blue dye was injected sterilely in a subareolar manner in 4 quadrants. The breast axilla were then prepped and draped.

Due to the extreme axillary location of this mass, the mass was excised first. An elliptical incision was made in the left upper quadrant of the breast. The wire was localized and brought into the field. This was held with an allis clamp. Using mayo scissors a cylinder of tissue was taken. Diving up towards the axilla the tissue was removed down to the level of the pectoralis muscle in the chest. The tissue was sent off for a mammographic analysis that recealed an adequate sample including the clip. At this time, using the Neoprobe a hot lymph node was identified. Through the same incision using blunt dissection to the axilla and clips ligating the lymphatic channels, the Sentinel lymph node was identified. This was brought out of the wound. The base of the lymph node was then clamped and excised. The target count of the lymph node was taken and 124. At this time the background count of the axilla was taken which was 8.

[tjanz1418]

I think it would be
19125
38525
38792

[Billington]

Should I also use 78195 for the preoperative lymphatic mapping?