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

Kaklamanos, Ioannis; Birbas, Konstantinos; Syrigos, Konstantinos; Bonatsos, Vasilios G.; Bonatsos, G.

doi:10.1002/jso.21897

Cited by 11 publications

(15 citation statements)

References 32 publications

(42 reference statements)

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“…The risk of bias assessment of the two RCTs demonstrated that they both possessed adequate sequence generation, calculation of a power analysis, satisfactory randomization, concealed allocation, addressed incomplete data, and were free from selective reporting and other biases ( Table ; Table S6 , supporting information). However, neither study stated whether the clinicians or patients in the trial were blinded.…”

Section: Resultsmentioning

confidence: 99%

“…These 18 studies underwent full‐text review and one further study was excluded from the systematic review on the basis of the absence of a preoperative diagnosis of invasive or in situ malignancy. Of the 17 studies remaining, another four were excluded from the meta‐analysis because there was no comparison of superficial versus deep injections of radiotracer with or without blue dye. Thus a total of 13 studies met the inclusion criteria for meta‐analysis ( Fig .…”

Section: Resultsmentioning

confidence: 99%

“…Of the 17 studies remaining, another four were excluded from the meta‐analysis because there was no comparison of superficial versus deep injections of radiotracer with or without blue dye. Thus a total of 13 studies met the inclusion criteria for meta‐analysis ( Fig . ).…”

Section: Resultsmentioning

confidence: 99%

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Meta-analysis of superficial versus deep injection of radioactive tracer and blue dye for lymphatic mapping and detection of sentinel lymph nodes in breast cancer

Ahmed

Purushotham

Horgan

et al. 2014

British Journal of Surgery

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Meta-analysis of superficial versus deep injection of radioactive tracer and blue dye for lymphatic mapping and detection of sentinel lymph nodes in breast cancer

Ahmed

Purushotham

Horgan

et al. 2014

British Journal of Surgery

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“…For instance, skin, fat and parenchymal necrosis have been reported [ 63 , 64 ]. Among the 18 studies included in present meta-analysis, Brahma reported that two patients experienced skin necrosis around the MBD injection site[ 44 ]; East reported that on patients developed skin and subcutaneous tissue necrosis around the MBD subareolar injection site[ 36 ]; and Kaklamanos reported that 3 patients suffered from skin allergic reaction[ 37 ]. No fat or parenchymal necrosis was reported.…”

Section: Discussionmentioning

confidence: 99%

Sentinel lymph node biopsy mapped with methylene blue dye alone in patients with breast cancer: A systematic review and meta-analysis

Xiao

et al. 2018

PLoS ONE

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BackgroundMethylene blue dye is easy to obtain in developing countries and can be used in sentinel lymph node mapping for breast cancer. However, the accuracy of methylene blue alone for sentinel lymph node mapping in breast cancer has not been well defined. In this study, we collected data to assess the feasibility and accuracy of sentinel lymph node biopsy mapped with methylene blue alone in patients with breast cancer.MethodsWe searched the PubMed, EMBASE, and Cochrane Library databases from January 1, 1993, to March 31, 2018. Selected studies had to have a defined group of patients with breast cancer in which MBD alone was used as the mapping technique for SNB.Results18 studies were included in this study. The combined identification rate was 91% [95% confidence interval (CI): 88%-94%, I2 = 68.3%], and the false negative rate was 13% (95% CI: 9%-18%, I2 = 36.7%). The pooled sensitivity, negative predictive value, and accuracy rate were 87% (95% CI: 82%-91%, I2 = 37.5%), 91% (95% CI: 87%-93%, I2 = 32.4%) and 94% (95% CI: 92%-96%, I2 = 29%), respectively.ConclusionsThis meta-analysis found that mapping sentinel lymph node locations with methylene blue dye alone results in an acceptable identification rate but an excessive false negative rate according to the American Society of Breast Surgeons’ recommendations. Caution is warranted when using methylene blue dye alone as the mapping method for sentinel lymph node biopsy.

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“…A transverse line marking the SLNB incision was drawn in the axilla about 2 cm below the axillary hair-bearing area. After induction of general anesthesia, 2 mL of methylene blue dye was injected in the subareolar area 16,22 and the injection site was massaged for 5 min. Then, the subcutaneous tissue beneath the marked line was cut open through the transverse skin incision of the modified radical mastectomy.…”

Section: Methodsmentioning

confidence: 99%

A Novel Finding of Sentinel Lymphatic Channels in Early Stage Breast Cancer Patients: Which May Influence Detection Rate and False-Negative Rate of Sentinel Lymph Node Biopsy

et al. 2012

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BackgroundThe exact lymphatic drainage pattern of the breast hasn't been explained clearly. The aim of this study was to investigate the sentinel lymphatic channels (SLCs) in the cancerous breast. Whether the type of SLCs influenced the detection rate and false-negative rate of SLNB was also assessed.Methodology and Principal FindingsMimic SLNB was performed in 110 early-stage breast cancer patients with subareolar injection of blue methylene dye intraoperatively. Postoperatively, 110 specimens of modified radical mastectomy were examined for all blue SLCs after additional injection of methylene dye in peritumoral parenchyma. Interestingly, three types of SLCs, including superficial sentinel lymphatic channel (SSLC), deep sentinel lymphatic channel (DSLC), and penetrating sentinel lymphatic channel (PSLC) were found in 107 patients. Six lymphatic drainage patterns based on the three types of SLCs were observed in these 107 patients. The proportions of the drainage pattern SSLC, DSLC, PSLC, SSLC+DSLC, SSLC+PSLC, and DSLC+PSLC in the breast were 43%, 0.9%, 15.9%, 33.6%, 3.7% and 2.8%, respectively. The lymphatic drainage pattern in the breast was a significant risk factor for unsuccessful identification of sentinel lymph nodes (P <0.001) and false-negatives in SLNB (P = 0.034) with the subareolar injection technique.ConclusionsThree kinds of SLCs are the basis of six lymphatic drainage patterns from the breast to the axilla. The type of SLCs is the factor influencing the detection rate and false-negative rate of SLNB. These findings suggest the optimal injection technique of the combination of superficial and deep injection in SLNB procedures. Future clinical studies are needed to confirm our novel findings.

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

Abstract: The use of MB alone is an efficient method for identification of the SLN. The PT injection route yields a higher number of SLNs than the SA route, comparable with the number of SLNs retrieved, when combined tracing agents and multiple injection sites are used.

Cited by 11 publications

References 32 publications

Meta-analysis of superficial versus deep injection of radioactive tracer and blue dye for lymphatic mapping and detection of sentinel lymph nodes in breast cancer

Meta-analysis of superficial versus deep injection of radioactive tracer and blue dye for lymphatic mapping and detection of sentinel lymph nodes in breast cancer

Sentinel lymph node biopsy mapped with methylene blue dye alone in patients with breast cancer: A systematic review and meta-analysis

A Novel Finding of Sentinel Lymphatic Channels in Early Stage Breast Cancer Patients: Which May Influence Detection Rate and False-Negative Rate of Sentinel Lymph Node Biopsy

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