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

Parasuraman, Madhivardhanam; Giridharan, Bhanumati; Vijaylakshmi,

doi:10.18203/2349-2902.isj20175879

Cited by 5 publications

(3 citation statements)

References 23 publications

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“…The low variability between two scorers illustrates that this visual assessment can be done by different observers and still yield the same score given to a sample. We hypothesize that the variability in scores between observers is seen when lymph node tissue coloration is ambiguous, if image quality is poor or due to differences in the learning curve ( 75 , 76 ) to discern blue staining. The intraobserver agreement of scores in our study are near perfect and scores did not even vary when the blinded observer scored the randomized images in batches at a different time.…”

Section: Discussionmentioning

confidence: 99%

Quantitative and Semi-quantitative Methods for Assessing the Degree of Methylene Blue Staining in Sentinel Lymph Nodes in Dogs

et al. 2021

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Background: To develop a digital algorithm for quantitative assessment of surface methylene blue staining in whole lymph nodes and validate a semi-quantitative visual scoring method for patient-side use.Methods: Lymph nodes from canine patients with spontaneous tumors undergoing sentinel lymph node mapping were prospectively assessed ex vivo and photographed. Using an open-source computer-based imaging software, an algorithm was developed for quantification of staining based on a signal-to-background ratio. Next, two blinded observers evaluated images and assigned a semi-quantitative visual score based on surface staining (0—no blue stain, 1−1–50% stained, and 2−51–100% stained) and those results were compared to the established quantitative standard.Results: Forty-three lymph nodes were included. Image analysis successfully quantified blue staining and differentiated from normal lymph node tissue in all cases. Agreement between observers using the Kappa coefficient demonstrated strong agreement (k = 0.8581, p < 0.0001) between semi-quantitative visual scoring and image analysis. There was substantial interobserver and intraobserver agreement for the scoring system (k = 0.7340, p < 0.0001 and k = 0.8983, p < 0.0001, respectively).Conclusion: A digital algorithm using an open-source software was simple and straightforward to use for quantification of blue staining. The use of a semi-quantitative visual scoring system shows promise for a simple, objective, repeatable assessment of methylene blue staining at the time of surgery. This study demonstrates reliable and repeatable methods for blue staining quantification thereby providing a novel and objective reporting mechanism in scientific research involving sentinel lymph node mapping.

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Section: Discussionmentioning

confidence: 99%

Quantitative and Semi-quantitative Methods for Assessing the Degree of Methylene Blue Staining in Sentinel Lymph Nodes in Dogs

et al. 2021

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“…8 Several studies have also reported that subareolar and periareolar injections promote higher SLN identification rates compared to peritumoral injections. [9][10][11][12] The optimal methylene blue dosage for SLNB remains controversial, with the most commonly used dosages being 2 and 5 ml. 13,14 Accordingly, Brahma et al, 5 who used 5 ml of methylene blue injected at the subareolar or peritumoral areas, obtained an SN detection rate of 91.7%.…”

Section: Discussionmentioning

confidence: 99%

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

Wibisana

Muliyadi

2020

Med J Indones

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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 (T1T2, 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 = 81.5499.51), 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.

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“…20,45 Adverse events related to performing leak testing were not well documented in any of the studies included in this review, with only Ijichi et al commenting on a single adverse event -common bile duct injury on insertion of the catheter with successful repair and uneventful postoperative recovery. 23 There is evidence that test substances used can cause allergic reactions, 47,48 and for the white test in particular, risks include fat embolie, immunosuppressive effects and fungal infection, 22,49 although all these are rare. The risk of barotrauma during dye injection, resulting in breakage of biliary ligatures, and resulting in either bile leakage, or reflux cholangitis has also been noted in the literature.…”

Section: Limitations Of Bile Leak Testingmentioning

confidence: 99%

The role of bile leak testing in liver resection: a systematic review and meta-analysis

Vaska

Abbas

2019

HPB

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Background: Bile leak following liver resection can be associated with significant morbidity. This systematic review and meta-analysis aims to evaluate the effect of intraoperative bile leak testing on postoperative bile leak rate and other complications after liver resection without biliary reconstruction for any cause. Methods: PubMed, MEDLINE, Embase, Cochrane Library and grey literature databases were searched for articles between 1960 and 2017 comparing bile leak rates with or without bile leak testing. Standard meta-analysis methods were used. The primary outcome was bile leak rate, and secondary outcomes were overall morbidity, reintervention rate and length of stay. Results: 8 articles met inclusion criteria. Intraoperative bile leak testing after resection was associated with lower postoperative bile leak rate (4.1% vs 12.3%, OR 0.36, 95% CI 0.23-0.55, p < 0.001), overall morbidity (OR 0.67, 95% CI 0.47-0.96, p = 0.030), need for reintervention (OR 0.11, 95% CI 0.03-0.36, p < 0.001) and a shorter duration of hospital stay (2.21 days, 95% CI 0.69-3.73, p = 0.004). Conclusion: The routine use of intraoperative bile leak testing during liver resection results in a significant reduction in postoperative bile leak rate, overall morbidity, length of hospital stay and need for reintervention. Bile leak testing should be performed after liver resection without biliary reconstruction.

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

Cited by 5 publications

References 23 publications

Quantitative and Semi-quantitative Methods for Assessing the Degree of Methylene Blue Staining in Sentinel Lymph Nodes in Dogs

Quantitative and Semi-quantitative Methods for Assessing the Degree of Methylene Blue Staining in Sentinel Lymph Nodes in Dogs

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

The role of bile leak testing in liver resection: a systematic review and meta-analysis

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