The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on endoscopic axillary lymph node retrieval for breast cancer in December 2005. In accordance with the Interventional Procedures Programme Process Guide, guidance on procedures with special arrangements are reviewed 3 years after publication and the procedure is reassessed if important new evidence is available.

The guidance was considered for reassessment in December 2008 and it was concluded that NICE will not be updating this guidance at this stage. However, if you believe there is new evidence which should warrant a review of our guidance, please contact us via the email address below.

Description

Endoscopic axillary lymph node retrieval is a minimally invasive technique for removing the lymph nodes in the armpit (axilla) in people with breast cancer. The lymph nodes are then examined for evidence of cancer spread. This is part of the process of staging, which helps to guide treatment.

Standard treatment involves surgeons removing lymph nodes for staging under direct vision through an incision in the axillary skin. In endoscopic axillary (axilloscopic) lymph node removal, the surgeon makes very small incisions in the axillary skin and removes the lymph nodes using an endoscope.

Endoscopic axillary sentinel node biopsy is a variation of the procedure involving injection of a dye into the breast lump. The single node to which the dye spreads first (the sentinel node) is removed and biopsied. If no cancer cells are found in that node, no further nodes are removed.

Coding recommendations

T85.2 Block dissection of axillary lymph nodes

Y76.3 Endoscopic approach to other body cavity

or

T86.2 Sampling of axillary lymph nodes

Y76.3 Endoscopic approach to other body cavity

or

T87.3 Excision or biopsy of axillary lymph node

Includes: Excision or biopsy of supraclavicular lymph node NEC

Y76.3 Endoscopic approach to other body cavity

In addition an ICD-10 code from category C50.- Malignant neoplasm of breast or C79.8 Secondary malignant neoplasm of other specified sites is assigned.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.