Breast Cancer Sentinel Node Detection: An Alternative Solution for Centers Lacking Nuclear Technology (original) (raw)
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A Study of Sentinel Lymph Node Biopsy with Methylene Blue Dye in Early Carcinoma of Breast
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Axillary lymph node status is very important prognostic factor in breast carcinoma patients; nodal evaluation is therefore a critical part of breast cancer management. However, axillary lymph node dissection results in significant morbidity. Thus, in the midnineties Sentinel Lymph Node Biopsy (SLNB) was introduced for staging in breast cancer patients. We carried out a study to find out whether the sentinel lymph node initially receives malignant cells from a breast carcinoma and whether a clear sentinel node reliably forecasts a disease-free axilla. MATERIALS AND METHODS Here 68 female patients with pathologically (FNAC/Trucut biopsy) proved early breast cancer without clinically palpable nodes, clinical stage T1/T2 N0M0, admitted in Krishna Institute of Medical Sciences, Karad from October 2014 to June 2016 who were to undergo modified radical mastectomy were selected for this study. Methylene blue dye (5 cc of 1% dye) was injected in subareolar region 20 minutes prior to surgery. The breast was then massaged for 5 minutes. Intraoperatively, sentinel lymph node were searched after raising superior flap. Dissection of axillary tissue to identify stained lymph node was done. All blue nodes and any node receiving a blue lymphatic channel were considered as sentinel nodes. After excising the stained lymph nodes, complete axillary clearance and removal of breast tissue was done. RESULTS Sentinel Lymph Node was identified in 61 cases out of a total of 68 cases in which the procedure was performed with a n identification rate of 89%. The overall sensitivity, specificity, Positive Predictive Value (PPV) and negative predictive value (NPV) of SLNB in predicting axillary node status was 93.33%, 83.87%, 84.84% and 92.85% respectively. A false negative rate of 6.67% was observed. CONCLUSION Our results show that this simplified technique of identifying the sentinel node(s) by using subareolar methylene blue has sufficiently high identification rate (89%). The results of the present study describe our initial experience with the SLNB technique, hence a false negative rate of 6.67% and negative predictive value of 92.85%, both of which are modifiable variables.
Asian Pacific Journal of Cancer Prevention
Aim: Sentinel Lymph Node Biopsy (SLNB) establishes as a gold standard for diagnostic lymph node involvement in early breast cancer. Most of the developed country does not have radiotracer and nuclear medicine facilities. Unless in Indonesia there is Methylene Blue as an alternative agent for SLNB. This study measure accuracy of sentinel lymph node biopsy as a single technique using the Methylene Blue test. Methods: This cross-sectional study enrolled 60 female patients with breast cancer stage I-II. We performed SNB using 2-5 cc of 1% Methylene-blue dye (MBD) injected to periareolar tissue and proceeded with axillary lymph nodes dissection (ALND). The histopathology results of sentinel nodes (SNs) and axillary lymph nodes (ALNs) analyze for diagnostic value assessments. Results: The identification rate of SN was 97.62 %, and the median number of identified SNs was 4 (2-7). Sentinel node metastasis was found in (19/60) % cases and % of them were macrometastases. The sensitivity and specificity of MBD were 91.67% and 96.67% respectively. The negative predictive value (NPV) of SNs to predict axillary metastasis was 96.67% (95% CI, 81-99%). Conclusion: Injection of 1% MBD as a single technique in breast cancer SNB has a favorable identification rate and predictive value.
World Journal of Surgical Oncology, 2017
Background: Axillary lymph node dissection (ALND) has been the standard treatment of breast cancer axillary staging in Indonesia. The limited facilities of radioisotope tracer and isosulfan or patent blue dye (PBD) have been the major obstacles to perform sentinel node biopsy (SNB) in our country. We studied the application of 1% methylene blue dye (MBD) alone for SNB to overcome the problem. Methods: This prospective study enrolled 108 patients with suspicious malignant lesions or breast cancer stages I-III. SNB was performed using 2-5 cc of 1% MBD and proceeded with ALND. The histopathology results of sentinel nodes (SNs) were compared with axillary lymph nodes (ALNs) for diagnostic value assessments. Results: There were 96 patients with invasive carcinoma from July 2012 to September 2014 who were included in the final analysis. The median age was 50 (25-69) years, and the median pathological tumor size was 3 cm (1-10). Identification rate of SNs was 91.7%, and the median number of the identified SNs was 2 (1-8). Sentinel node metastasis was found in 53.4% cases and 89.4% of them were macrometastases. The negative predictive value (NPV) of SNs to predict axillary metastasis was 90% (95% CI, 81-99%). There were no anaphylactic reactions, but we found 2 cases with skin necrosis. Conclusions: The application of 1% MBD as a single technique in breast cancer SNB has favorable identification rates and predictive values. It can be used for axillary staging, but nevertheless the technique should be applied with attention to the tumor size and grade to avoid false negative results.
BMC Surgery, 2013
Background Metastasis in the axillary lymph nodes is the most important known prognostic factor for breast cancer. We aimed to investigate the contribution of the radioisotope tracer method to the dye-only method by performing sentinel lymph node biopsy on the same patient group during a single surgical session. Methods Forty-two patients who underwent operations in our clinic from February 2010 to October 2011 and with masses of <5 cm and clinically and radiologicallly negative axilla (T1-2 N0) were prospectively included in this study. After paraffin examination results were obtained, the numbers and metastatic states of the lymph nodes that were unidentifiable during surgery (although they were stained) but were detected by a gamma probe, lymph nodes that were only stained, lymph nodes that were only radioactive (hot), and lymph nodes that were both stained and radioactive (stained-hot) were determined in all patients. In patients who underwent axillary lymph node dissection, ...
2020
BACKGROUND: Sentinel lymph node (SNL) biopsy in breast cancer for the determination of axillary status is standard procedures in surgical treatment of early-stage breast cancer. The identification of the SNL is usually performed by radiocolloid injection or/and injection of methylene blue due. The use of indocyanine green (ICG) dye, which is fluorescent dye, which movement in breast and axillar pit, can be followed with special cameras which detect near infrared specatar of light. CASE REPORT: In this paper, we present case report of patient with breast cancer, where we perform SNL detection with three methods: Use of radiocolloid which we trace with static gamma camera, and intraoperatively with hand held gamma probe, methylene blue dye which movement we followed by eye contact and using indocyanine green which movement was followed by specially constructed multispectral camera, which can detect near-infrared fluorescence that is emitted by ICG and methyline blue, respectively. CON...
Breast care (Basel, Switzerland), 2016
We aimed at examining the potential benefits of blue dye in sentinel node biopsy (SNB) in comparison with its proven drawbacks. In 2007, 203 T1 primary breast carcinomas had been operated on in our institute. The patients had undergone a lumpectomy and SNB. Sentinel node (SN) detection was exclusively isotopic (ISO) in 77 patients and performed with blue dye combined with a radioactive isotope (COMBI) in 126 patients. We compared the number of SNs and the rate of SN positivity in both groups. The detection rate was 99% in both groups: 76/77 in the ISO group and 125/126 in the COMBI group. The mean number of SNs was 2.14 and 1.91 in the ISO group and the COMBI group, respectively (difference not significant (NS)). SN positivity was found in 26.1% and 24.6% in the ISO group and the COMBI group, respectively (NS). Only 1 SN had been removed in 26% of the patients in the ISO group versus 45.2% of the patients in the COMBI group (p = 0.004). No significant differences were observed in th...
Revista da Associação Médica Brasileira, 2017
Summary Introduction: Methylene blue is more widely available and less expensive than patent blue, with an apparently lower risk of anaphylaxis. Objective: The two dyes were compared regarding detection of the sentinel lymph node (SLN). Method: A prospective, randomized trial involved 142 patients with invasive breast carcinoma. Sixty-nine (49.3%) assigned to patent blue (group A) and 71 (50.70%) to methylene blue (group B). Thirty-five patients (25.0%) were clinical stage III or IV; 55 (38.7%) had axillary lymph nodes affected; and 69 (49.3%) underwent neoadjuvant chemotherapy. Two patients were excluded because the dye type was not recorded. Results: Patients and tumor characteristics were similar in both groups. SLNs were identified in 47 women (68.1%) in group A and 43 (60.6%) in group B (p=0.35). SLNs were affected in 22 cases (51.2%) in group A and 21 (48.8%) in group B (p=0.62). The SLN was the only node affected in 12 cases (54.5%) in group A and six (33.3%) in group B (p=0....
International Surgery Journal
Background: Modern screening methods has made it possible to diagnose breast cancer in as early stage as possible and axillary lymph node status is still the most important prognostic indicator in carcinoma breast. In this study we are trying to analyse the preference of lymph nodal staining in SLNB using methylene blue in early breast cancer, so that surgeons will be more aware of anatomical positions of the stained nodes, thus favouring more precise dissection, reducing the morbidity.Methods: This was a prospective observational study conducted in the Department of General Surgery, Government Medical College, Kottayam. All cases of clinically N0 carcinoma breast undergoing modified radical mastectomy were included. We injected 3 ml of methylene blue in the subareolar region in three places depending on the quadrant in which tumour was situated, before putting the skin incision for modified radical mastectomy and the pathologist segregated the stained lymph nodes after confirming t...