Background: Our study describes the use of methylene blue dye as an alternative to isosulfan blue dye to identify the sentinel lymph node (SLN).
Methods: A retrospective analysis was performed of 112 breast cancer patients (113 axillae) who underwent SLN biopsy (SLNB) with methylene blue dye and 99mTc-labeled sulfur colloid for SLN identification. All SLNs were submitted for intraoperative frozen section analysis, hematoxylin and eosin stain, and immunohistochemical evaluation. Patients with a pathologically negative SLN did not undergo further axillary lymph node dissection.
Results: Of 112 patients who underwent SLNB, the SLN was identified in 107 (95.5%); 104 (92.8%) were identified by methylene blue dye. In a subset of 99 patients with recorded isotope status in relation to blue nodes, concordant identification with both dye and isotope was observed in 94 (94.9%). Of patients with identified SLNs, 32 (29.9%) of 107 contained metastatic disease, with 31 (96.9%) of 32 identified by methylene blue dye. The SLN was the only positive node in 18 (60.0%) of 30 patients.
Conclusions: SLNB with methylene blue dye is an effective alternative to isosulfan blue dye for accurately identifying SLNs in breast cancer patients.
Methylene blue Sentinel node Isosulfan blue Breast cancer Sentinel lymph node biopsy
Cascinelli N, Belli F, Santinami M, et al. Sentinel lymph node biopsy in cutaneous melanoma: the WHO Melanoma Program experience. Ann Surg Oncol 2000; 7: 469–74.PubMedGoogle Scholar
Medina-Franco H, Beenken SW, Heslin MJ, Urist MM. Sentinel node biopsy for cutaneous melanoma in the head and neck. Ann Surg Oncol 2001; 8: 716–9.PubMedGoogle Scholar
Link EM, Costa DC, Lane D, Blower PJ, Spittle MF. Radioiodinated methylene blue for diagnosing early melanoma metastases. Lancet 1996; 348: 753.PubMedGoogle Scholar
Landra M, Acchiardi F, Pugno F, Forte G, Granetto C, Camuzzini GF. Sentinel node mapping for malignant melanoma. Tumori 2000; 86: 354–5.PubMedGoogle Scholar
Fukui Y, Yamakawa T, Taniki T, Numoto S, Miki H, Monden Y. Sentinel lymph node biopsy in patients with papillary thyroid carcinoma. Cancer 2001; 92: 2868–74.PubMedGoogle Scholar
Cserni G. Metastases in axillary sentinel lymph nodes in breast cancer as detected by intensive histopathological work up. J Clin Pathol 1999; 52: 922–4.CrossRefPubMedGoogle Scholar
Weaver DL, Krag DN, Ashikaga T, et al. Pathologic analysis of sentinel and nonsentinel lymph nodes in breast carcinoma: a multicenter study. Cancer 2000; 88: 1099–107.PubMedGoogle Scholar
Simmons RM, Smith SMR, Osborne MP. Methylene blue as an alternative to isosulfan blue dye for sentinel lymph node localization. Breast J 2001; 7: 181–3.PubMedGoogle Scholar
Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 1994; 220: 391–401.PubMedGoogle Scholar
O’Hea BJ, Hill AD, El-Shirbiny AM, et al. Sentinel lymph node biopsy in breast cancer: initial experience at Memorial Sloan-Kettering Cancer Center. J Am Cancer Soc 1998; 186: 423–7.Google Scholar
Bass SS, Cox CE, Ku NN, Berman C, Reintgen DS. The role of sentinel node biopsy in breast cancer. J Am Cancer Soc 1999; 189: 183–94.Google Scholar
Giuliano AE, Jones RC, Brennan M, Statman R. Sentinel lymphadenectomy in breast cancer. J Clin Oncol 1997; 15: 2345–50.PubMedGoogle Scholar
Derossis AM, Fey J, Yeung H, et al. A trend analysis of the relative value of blue dye and isotope localization in 2,000 consecutive cases of sentinel node biopsy for breast cancer. J Am Coll Surg 2001; 93: 473–8.Google Scholar
McMasters KM, Tuttle TM, Carlson DJ, et al. Sentinel lymph node biopsy for breast cancer: a suitable alternative to routine axillary dissection in multi-institutional practice when optimal technique is used. J Clin Oncol 2000; 18: 2560–6.PubMedGoogle Scholar
Tafra LC, Lannin DR, Swanson MS, et al. Multicenter trial of sentinel node biopsy for breast cancer using both technetium sulfur colloid and isosulfan blue dye. Ann Surg 2001; 233: 51–9.PubMedGoogle Scholar
Tanis PJ, Deurloo EE, Valdes Olmos RA, et al. Single intralesional tracer dose for radio-guided excision of clinically occult breast cancer and sentinel node. Ann Surg Oncol 2001; 8: 850–5.PubMedGoogle Scholar
Linehan DC, Hill ADK, Akhurst T, et al. Intradermal radiocolloid and intraparenchymal blue dye injection optimize sentinel node identification in breast cancer patients. Ann Surg Oncol 1999; 6: 450–4.PubMedGoogle Scholar
Albertini JJ, Lyman GH, Cox C, et al. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA 1996; 276: 1818–22.CrossRefPubMedGoogle Scholar
Koller M, Barsuk D, Zippel D, Engelberg S, Ben-Ari G, Papa MZ. Sentinel lymph node involvement: a predictor for axillary node status with breast cancer—has the time come? Eur J Surg Oncol 1998; 24: 166–8.PubMedGoogle Scholar
Borgstein PJ, Pijper R, Comans EF, van Diest PJ, Boom RP, Meijer S. Sentinel lymph node biopsy in breast cancer: guidelines and pitfalls of lymphoscintigraphy and gamma probe detection. J Am Cancer Soc 1998; 186: 275–83.Google Scholar
Hsueh EC, Turner RR, Glass EC, Brenner RJ, Brennan M, Giuliano AE. Sentinel node biopsy in breast cancer. J Am Cancer Soc 1999; 189: 207–13.Google Scholar
Gann PH, Colilla SA, Gapstur SM, et al. Factors associated with axillary lymph node metastasis from breast cancer: descriptive and predictive analyses. Cancer 1999; 86: 1511–9.PubMedGoogle Scholar
Chao C, Wong SL, Ackermann D, et al. Utility of intraoperative frozen section analysis of sentinel lymph nodes in breast cancer. Am J Surg 2001; 182: 609–15.PubMedGoogle Scholar
Albo D, Wayne JD, Hunt KK, et al. Anaphylactic reactions to isosulfan blue dye during sentinel lymph node biopsy for breast cancer. Am J Surg 2001; 182: 393–8.PubMedGoogle Scholar
Cimmino VM, Brown AC, Szocik JF, et al. Allergic reactions to isosulfan blue during sentinel node biopsy—a common event. Surgery 2001; 130: 439–42.PubMedGoogle Scholar
Longnecker SM, Guzzardo MM, Van Voris LP. Life-threatening anaphylaxis following subcutaneous administration of isosulfan blue 1%. Clin Pharm 1995; 4: 219–21.Google Scholar
Leong SP, Donegan E, Heffernon W, et al. Adverse reactions to isosulfan blue during selective sentinel lymph node dissection in melanoma. Ann Surg Oncol 2000; 7: 361–6.PubMedGoogle Scholar
Laurie SA, Khan DA, Gruchalla RS, Peters G. Anaphylaxis to isosulfan blue. Ann Allergy Asthma Immunol 2002; 88: 64–6.PubMedCrossRefGoogle Scholar