Accuracy of Sentinel Node Biopsy for Breast Cancer Using Blue Dye Alone

Abstract

Blue dye alone (BDA), lymphoscintigraphy alone, or, a combination of the two techniques are used for sentinel node biopsy (SNB) in breast cancer. This study reviews the effectiveness of the SNB technique using BDA by measuring the node identification rate and comparing the cohort node positivity with expected rates from established nomograms. A consecutive case series was examined from the database. This included the learning experience of six surgeons. Patients with unifocal tumors estimated at less than 31 mm were eligible. The tumor and axillary nodal histology was recorded. Published data were then used to calculate and predict node positivity rates in the study according to the size and grade of the tumors. There were 332 SNB procedures from 2001 to 2008. BDA successfully identified nodes in 94.6% (314/332) of the cases. The identification rate improved with experience. In patients with invasive cancer, 28.4% (85/299) of SNB were found to be positive for metastases or micrometastases. The node identification rate and the node positivity rate were found to be within published predicted ranges for the size and grade of the study tumors. The SNB with BDA was found to be effective in identifying sentinel nodes (SLN) in breast cancer. Surgeon experience was a factor in the success of the technique. Rates of detecting metastases were consistent with internationally published data, suggesting that BDA may perform as well as other techniques in experienced hands.

Potential advantage of preoperative three-dimensional mapping of sentinel nodes in breast cancer by a hybrid single photon emission CT (SPECT)/CT system

“…This finding is consistent with the consensus statement from the College of American Pathologists that does not recommend using IHC in the evaluation of SLNs. 2 Although results from the ACOSOG Z0010 trial are compelling and suggest that routine use of IHC in SLN evaluation is unnecessary, we would highlight one finding from the current article that is consistent with data previously published from our institution, 3 namely a relationship between invasive lobular histology and a higher incidence of positive SLNs on IHC staining. Invasive lobular tumors have a different architecture and more often have …”

“…However, the literature is replete with articles showing detection rates of less than 90%. [1][2][3][4] While the authors report a detection rate of 97.3%, they quote Lerman and colleagues 5 who believed that this hybrid methodology was more accurate (particularly in overweight patients) but reported a detection rate of only 90%. Another potentially confounding variable is the different technetium chelates used in reported results of SN biopsy.…”

Prospective comparison of peritumoral and subareolar injection of blue dye alone, for identification of sentinel lymph nodes in patients with early stage breast cancer

“…Finally results from the ALMANAC study show that although the identification rate of the combined method was superior to BD alone (85.6% vs. 96%), there was no significant difference between the two techniques in identifying the positive nodes [10]. In contrast to these studies, other investigators do not find any evidence of higher identification rate of the combined technique versus blue dye alone [16,17] or radioisotope alone [18].…”

Blue dye is sufficient for sentinel lymph node biopsy in breast cancer

“…However, with improvements in radioisotope imaging and shielding, greater familiarity with the technique and absence of serious allergic reactions typical of those seen with blue dyes, many authors began to advocate the sole use of radiocolloids. Initial studies reported that blue dye alone performed poorly without the concomitant use of radiocolloids, but results comparable with dual‐modality SLN biopsy have been documented more recently. Serious allergic reactions were reported to be rare.…”