Can Methylene Blue Only Be Used in Sentinel Lymph Node Biopsy for Breast Cancer?

Abstract

Sentinel lymph node biopsy (SLNB) has become an accepted standard of care to stage the axilla for clinically node-negative early stage breast cancer. In experienced hands, studies have shown an acceptable rate of identification of the sentinel lymph node (SLN) with blue dye only. Lymphazurin is occasionally associated with severe allergic reaction, including anaphylaxis and death. The use of methylene blue alone as a method of identifying the SLN in breast cancer has been reported once previously in the literature. Methylene blue may be an acceptable alternative with fewer deleterious side effects. Medical records of patients, who underwent sentinel node mapping between September 2003 and March 2005 by two surgeons at an academic medical center were reviewed. SLN mapping was performed by periareolar injection of 5 cc of 1% methylene blue. All patients with positive SLNs underwent completion axillary node dissection. During the study period, 141 consecutive patients with clinically node-negative axillas and without evidence of inflammatory breast cancer underwent SLNB with injection of methylene blue only. A SLN was identified in 136 of 141 patients (96.5%). Thirty-three of 136 SLNs (24%) harbored metastatic disease. No cases of anaphylaxis were noted. In experienced hands, methylene blue alone is a highly sensitive method of detecting SLNs. Avoiding the greater frequency of allergic reactions seen with lymphazurin is an important advantage of methylene blue.

Sentinel lymph node biopsy in early breast cancer surgery – Working with the risks of vital blue dye to reap the benefits

“…one study demonstrate an identification rate of 98.7% in 329 early breast cancer patients 65 . Other studies have shown similar identification rates [73][74][75] . The other advantages of using Methylene blue include its lower cost 74 and wider availability.…”

Use of methylene blue for the detection of sentinel lymph node in breast cancer: a systematic review and meta-analysis

“…All the papers analyse the use of methylene blue in the SLN detection. 16 In a study done by Golshan and Nakhlis it was found that MBD is the only substitute for lymphazurin. 17 There is occurrence of allergic and anaphylactic reaction between 1% and 3% with lymphazurin.…”

“…Golshan and Nakhlis state that the methylene blue dye is cheaper compared to Lymphazurin dye. 16 Moreover, methylene blue has no side effects and no allergic or anaphylactic reaction is reported like Lymphazurin hence safer than Lymphazurin. Mathelin et al, state that molecular weight of methylene blue is 319.9 whereas that of Isosulphan blue is 543.…”

Efficacy of Methylene Blue in Sentinel Lymph Node Biopsy for Early Breast Cancer

“…In studies conducted in our country isosulphane blue was often preferred (9)(10)(11). In the literature, there are many studies showing that methylene blue can be used safely and with high success as an alternative to isosulphane blue (12)(13)(14)(15) Core biopsy is the gold standard in the diagnosis of breast cancer, although there are physicians who prefer excisional biopsy. Some of our patients were referred to our clinic with a diagnosis and we chose to include the patients in whom excisional biopsy was previously performed into the study.…”