Blue-dye technique complements four-node sampling for early breast cancer
Introduction
Axillary sentinel lymph nodes (SNs) may be identified by either radio-isotope or blue dye methods.1, 2, 3, 4 False negatives are half as frequent with a combined technique as with a single-agent SN mapping technique.5 Radio-isotope mapping of SN succeeds more often than mapping by blue dye: 92 vs 81%.6
Four-node axillary sampling has been developed as a means of staging the axilla.7 Several studies have shown four-node sampling techniques to be as accurate for prognosis as axillary lymph node dissection, with no differences in axillary recurrence rates between women staged by either method.7, 8, 9 SNB performed using radiolabelled colloid may have no advantage over four-node axillary sampling (4NAS).10 4NAS may not provide additional information in patients who have SN identified by a combination of isotope-labelled colloid and patent blue dye techniques.11
We decided to examine whether four-node axillary sampling assisted by a blue dye (4NAS/dye) is feasible at our institutions. The feasibility studies followed a suggestion for the clinical application of SNB by the American College of Surgeons, that each institution's principal investigator be required to document a 90% accuracy rate and a 90% staging accuracy in at least 30 consecutive cases of SNB followed by complete axillary lymph node dissection.12 We also present here the preliminary results of an observational study of 4NAS/dye performed after the feasibility study was completed.
Section snippets
Feasibility study
The study population comprised 33 consecutive cases with breast cancer in categories N0 and N1 of the UICC/AJCC common staging system. The Local Ethics Committee of Yokohama City University approved the study, and written informed consent was obtained from all participants. Diagnosis was made pre-operatively by fine needle biopsy in the majority of cases. Thirteen patients had undergone diagnostic excisional biopsy prior to SNB. All surgical procedures were performed by the same surgeon (T.I.)
Feasibility study
The median age of the patients was 53 years (range 26–75 years). The number of blue-stained nodes per case was 1.7±1.0 (mean±SE, range 0–4) and that of nodes excised for 4NAS/dye was 3.4±1.2 (range 0–7). The total number of nodes harvested (4NAS/dye and axillary clearance) was 18±7 (range 0–32). Details of patient characteristics are shown in Table 1. Intraoperatively, axillary nodes were identified in 27/33 cases (81.8%) by the dye alone and in 32/33 cases (97.0%) by 4NAS/dye (Fig. 1). Of the
Discussion
Although technical issues regarding the methods used to identify the SN continue to be debated, it is rather important that groups involved in SNB must determine their own false-negative rates for procedures. Such determination requires a concomitant axillary lymph node dissection to validate the accuracy.
Compared with a previous report,13 our results by the dye-alone method were unfavorable. These were attributable to a lack of experience in SNB among our surgeons and probably to the inclusion
Acknowledgements
We thank Prof RW Blamey and Prof JFR Robertson for providing Oncology Course Training Programme in Nottingham, 1999.
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Cited by (13)
A prospective feasibility study of sentinel node biopsy by modified Indigocarmine blue dye methods after neoadjuvant chemotherapy for breast cancer
2015, European Journal of Surgical OncologyCitation Excerpt :The number of removed sentinel nodes depends on cases and it is not necessarily four. In 2005, we reported the feasibility of the 4NAS/dye method without NAC.9 These results were comparable to those of a combination of RI and dye methods.
The accuracy of sentinel node biopsy in breast cancer patients with the history of previous surgical biopsy of the primary lesion: Systematic review and meta-analysis of the literature
2012, European Journal of Surgical OncologyCitation Excerpt :As shown in Supplementary file 1, 68 studies were included in the review,9,11,21–86 and the remaining were excluded (for the reasons mentioned in Supplementary file 1). Three studies had two different sub-groups and were included as separate studies in the meta-analysis.23,71,80 Overall 68 studies (including those with sub-groups) had enough information for detection rate and 18 studies for false negative rate evaluation.
Observational study of blue dye-assisted four-node sampling for axillary staging in early breast cancer
2010, European Journal of Surgical OncologyCitation Excerpt :Even in Western countries, reports indicate that some surgeons perform SNB using only a blue dye due to a lack of RI facilities13 or for geographical reasons (such as difficulty in accessing nuclear medicine facilities or lack of availability of radiolabelled tracer).14 In 2000–2002, we performed a feasibility study of blue dye-assisted four-node axillary sampling (4NAS/dye), and demonstrated that the method is more accurate than the use of only a blue dye for the detection of SNs.15 On the basis of these findings, we discontinued ALND from our treatment approach when negative SNs were detected during intraoperative 4NAS/dye.
Combination blue dye sentinel lymph node biopsy and axillary node sampling: The Edinburgh experience
2008, European Journal of Surgical OncologyComment on "Blue-dye technique complements four-node sampling for early breast cancer"
2007, European Journal of Surgical Oncology