Comparison between sentinel lymph node hybrid scintigraphy and blue dye technique in breast cancer patients: An institutional experience

Abstract

To compare the detection efficacy of radionuclide lymphoscintigraphy (LS) versus patent blue dye (PBD) technique for hidden sentinel lymph node (SLN) in breast cancer patients and to determine which modality is better for SLN detection. One hundred and thirty-four early stage breast cancer female patients with clinically negative axilla who underwent post technetium-99m nanocolloid injection single photon emission computed tomography (SPECT-CT) for negative SLN on planar imaging were studied prospectively between 2015 and 2017. Following SPECT-CT, patients underwent peroperative gamma probe count detection GP-CD and PBD technique. Visually, blue stained ± hot nodes were surgically removed and subjected to histopathological analysis. The detection rate by individual method was calculated. Kappa statistics were applied to calculate overall agreement between radioisotope and PBD techniques for diagnostic value assessment. One hundred and thirty-four patients underwent SPECT-CT LS and PBD injection. Mean age: 47 ± 7.6 years (range: 26–82 years). Forty-nine (36.6%) had T1 and 85 (63.4%) T2. SPECT-CT LS detected SLN in 105/134 cases (success rate: 78.4%), later GP-CD localized “hot nodes”in additional 20 cases (success rate: 93.3%). The PBD successfully localized SLN in 131/134 (97.8%) cases. Three cases remained negative on both radioisotope and PBD localization, which on subsequent nodal dissection had metastatic disease. All SLNs detected on SPECT-CT showed blue dye uptake. In 112 cases, more than one SLN was surgically removed. Frozen section analysis of excised SLNs showed metastasis in 31%. Overall moderate agreement (k = 0.56) was calculated. No statistically significant difference was seen between isotope detection and PBD. Radionuclide sentinel mapping has good detection rate particularly combined with peroperative GP-CD. The PBD has added value to reduce false-negative rate of SLN mapping and can substitute radionuclide imaging with negative results.

Early Institutional Experience of Dual Tracer and Single-Photon Emission Computed-Tomography/Computed-Tomography Mapping for Sentinel Node Biopsy: A Report of Two Early-Stage Breast Cancer

“…7,15 SPECT/CT, however, may not be advised for all breast cancer patients due to additional cost and irradiation-although it is deemed safe for pregnant surgeons and patients. 5 Nonetheless, current evidence suggests that it is indicated whenever planar imaging is difficult to interpret, equivocal, or negative. 7 Newer tracers such as indocyanine green (ICG) have also been successfully developed for SLNM.…”

“…2,3 Combining blue dye with radioisotope was found to yield a superior IR and FNR compared to using either tracer alone. 1,4,5 Although no standard methodology exists, the dual tracer technique (DTT) is considered as the gold-standard in many guidelines. Recently, single-photon emission computed-tomography/computed-tomography (SPECT/CT) was also incorporated in the preoperative SLNM workflow.…”

Advanced diagnostic imaging of sentinel lymph node in early stage breast cancer

“… 5 Regarding radioactivity, attention should be paid to the “hottest” SLN, and all nodes counted as 10% or more of the hottest node should be removed (the “10% rule”). 6 Krzhivitskii et al 7 believed that increased tracer uptake with/without LN expansion can be used as markers of tumor metastasis. Taking the histopathological results as a reference, the accuracy of mixed SPECT and CT imaging in diagnosing early stage breast cancer clinically negative LN patients with axillary LN metastasis can reach 99%.…”

Assessment of Intraparenchymal Injection of 1% Patent Blue Dye in the Upper Outer Quadrant of the Breast to Identify Sentinel Lymph Node in Early Retro‐Areolar Breast Cancer in Women: A Tertiary Centre Experience in Egypt

“…Moreover, concerns over radiation exposure hazards form an obstacle in front of the use of the combined method as most hospitals do not have the experience or specific equipment to deal with the disposal of radioactive waste [9]. On the other hand, patent blue is a cheaper, more available option and has been approved to be used in identification of SNB [10]. Furthermore, we noticed the promising results when we had to inject the patent blue dye into the upper outer quadrant of the breast in special circumstances such as previous breast surgery (to avoid disrupted lymphatic channels); therefore, we planned our study to assess the efficacy of the lateral patent blue dye injection technique (validated by radioactive nanocolloid) in central breast tumours in comparison with the classic retro‐areolar blue dye injection.…”