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

Abstract

Objective: Sentinel lymph node biopsy is the recommended approach in the evaluation of axilla during breast cancer surgery. In this study, results of patients who underwent methylene blue sentinel lymph node biopsy were evaluated. Materials and Methods:The study included 32 female patients with T1 and T2 tumors. 5 ml of 1% methylene blue was injected into the peritumoral area or around the cavity. The axillary sentinel lymph node was found and removed, and then axillary dissection was performed. The sentinel lymph node and axillary dissection specimen were histopathologically examined and the results were compared. Results:The sentinel lymph node was found in 30 (94%) patients. Lymph node metastasis was not observed in 17 patients in both the sentinel lymph node and axilla. Two patients had metastasis in the axilla although this was not detected in sentinel lymph node. Eleven patients had metastasis both in the sentinel lymph node and in the axilla . The accuracy rate was 93%, and the false negativity rate was identified as 15%. Conclusion:Sentinel lymph node biopsy by methylene blue is a method that can be applied with high accuracy. Methylene blue can be considered as an alternative to isosulphane blue in sentinel lymph node biopsy.

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

“…However, Ozdemir et al reported no such risks while using methylene blue dye. 30 In the study done by Fattahi et al, the demographic and histopathologic characteristics were not considerably different in patent blue dye group and methylene blue dye group. 32 All the patients had a mean tumour size of 2.4cm with standard deviation of 0.8cm.…”

“…In study done by Ozdemir et al, Isosulphane blue or methylene blue was injected in the first method. 30 Radioactive material was injected first, and the sentinel lymph node was found with a gamma probe in another method. This study suggests that these two methods can be used in combination.…”

“…Ozdemir et al compare isosulphan with methylene blue. 30 They also observe that methylene blue is cheaper than isosulphan and isosulphan has a hypersensitivity of 0.6% to 2.5%. The accuracy of methylene blue is 92.7% whereas that of isosulphan blue is 88.5%.…”

Validating a semi-quantitative method to assess the degree of methylene blue staining in sentinel lymph nodes

“…Reports indicate identification rates (IR) as a point of success in the SLN mapping process 4 , although appropriate criteria for successful identification of a SLN is often missing. Clinical trials involving SLN mapping outline inclusion criteria for SLNs reported based on nodes that are only stained blue 2,8,23-28 , blue and non-blue nodes with dye uptake in afferent lymphatic channels 11,12,14,[29][30][31][32][33][34][35] , or do not comment on IR inclusion criteria [36][37][38] . The inconsistent or lack of standardized, objective reporting across SLN mapping trials and cases that utilize methylene blue skews accuracy and reduces comparability of results between studies.…”

The Formulation of Methylene Blue Encapsulated, Tc-99m Labeled Multifunctional Liposomes for Sentinel Lymph Node Imaging and Therapy

“…Additionally, its side effects are less serious than isosulphane blue. 1,2 The limiting factor of MB is its poor penetration through the cell membranes and some allergic reactions. Radiopharmaceuticals have been used as an alternative or in addition to dyes for external imaging and/or radiation detector monitoring for the SLN detection and mapping before surgery.…”