Sentinel lymph node biopsy for breast cancer using methylene blue: a new anatomical landmark involving intercostobrachial and medial pectoral nodes

Abstract

BACKGROUND Sentinel lymph node biopsy (SLNB) using blue dye is becoming popular in Indonesia given that knowledge on new anatomical landmarks involving intercostobrachial and medial pectoral nodes have replaced the need for radioisotope tracers. This study aimed to evaluate the utility of the proposed landmark involving intercostobrachial and medial pectoral nodes to determine axillary lymph node status during SLNB.
 METHODS A prospective study was conducted involving 55 patients with early-stage breast cancer who had clinically negative lymph nodes (T1–T2, cN0) between 2018 and 2019 at Cipto Mangunkusumo Hospital. During SLNB, methylene blue 1% was injected at the subareolar area to identify intercostobrachial and medial pectoral nodes followed by axillary lymph node dissection (ALND). Histopathological results of sentinel nodes (SNs) were then compared to those of other axillary nodes.
 RESULTS SNs were identified in 54 patients (98%), 33 (61%) of whom had both intercostobrachial and medial pectoral SNs. Among patients with SNs, there were 1 patient without intercostobrachial SNs, 10 patients without medial pectoral SNs, and 1 patient with medial pectoral SNs but no intercostobrachial SNs. Accordingly, SNs had a negative predictive value (NPV) of 96.77% for axillary metastasis (95% confidence interval = 81.54–99.51), with a false negative rate of 4.7%. No serious adverse events was observed.
 CONCLUSIONS The high identification rate and NPV, as well as the low false negative rate of the new anatomical landmark involving intercostobrachial and medial pectoral nodes during SLNB, suggest its reliability in determining axillary lymph node status.

Accuracy Rate of Methylene Blue Injection in Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer Patients: A Prospective Observational Study

“…without metastatic lymph nodes (cN0), 70-80% of these patients have pathologically cancer cell-free lymph nodes (pN0), increasing the risk of unnecessary procedures such as arm lymphedema, axillary sensory impairment, and shoulder adduction deficits. [28][29][30][31][32] This study found that the accuracy of SNLB compared to the histological examination from the axillary lymph node dissection showed a sensitivity of 82.8% and a specificity of 88%. This value is slightly different for patients who have had different types of biopsies.…”

Role of Hormonal Receptor in Predicting Sentinel Lymph Node Metastasis in Early Breast Cancer

“…In Indonesia, notwithstanding, SLNB for breast malignant growth presently can’t seem to become mainstream thinking about a few variables, including patient qualities (most as of now had the high level stage illness), hazy proposals, and restricted offices for radioisotope use because of significant expenses and inaccessibility in most disease communities ( 9 ). The previously mentioned factors are compounded by the way that Indonesia comprises of numerous islands, making admittance to malignancy focuses considerably more troublesome.…”

“…Estrogen receptor a (ERa) activation promotes tumorigenesis in different types of cancer, including axillary metastasis breast cancer. The estrogen receptor is a member of the nuclear receptor superfamily and is involved in various developmental and physiological processes ( 5 , 9 ).…”

“…Activated ERK1/2 are then translocated to the nucleus and promote phosphorylation of Ser 118 in the AF-1 domain of ER and activate its ER-target gene transcriptional activity. These procedures are quite essential in the progression of metastasis of breast cancer through axillary lymph node ( 5 , 9 ).…”