Intraoperative Use of Methylene Blue for Sentinel Lymph Node Detection in Breast Cancer Surgery: A Prospective Study
DOI:
https://doi.org/10.63682/jns.v13i1.8265Abstract
Background: SLNB is suggested for breast cancer patients with histologically negative axillary nodes. It inhibits axillary lymph node dissection. Excellent intrinsic accuracy and low axillary nodal metastatic load (subject to patient selection) explain SLNB's low false negative rate, especially with blue dye. Location, injection site, mapping agent, volume, axillary nodal metastatic burden, and dissection competency impact SLN identification.
Objective: The purpose of this research is to evaluate the efficacy of incisional and excisional biopsy methods for determining the rate of methylene blue injection into sentinel lymph nodes in patients with early-stage breast cancer.
Methods:Participants in this study were women who had undergone a breast cancer biopsy and were in the early stages of the disease, meaning there was no lymph node metastases (N0). In this investigation, 110 people were considered. Methylene blue was injected into the peritumoral region before the sentinel lymph node biopsy. A positive lymph node biopsy result was indicated by blue nodes in the axilla, which were then sent for histopathology analysis.
Results:In our study mean age of the included females was 47.13±10.76 years and had mean BMI 26.13±27.59 kg/m2. Majority of the cases 73 (66.4%) had tumor on right side of breast and 37 (33.6%) cases had tumor on left side.The sensitivity rate for patients who had excisional biopsy surgery was 84% and the specificity rate was 92%, whereas the accuracy rate for patients who had incisional biopsy surgery was 78% and the specificity rate was 81%.
Conclusion: In this study, we found no difference in the accuracy of SLNB using methylene blue in patients with early-stage breast cancer with N0 and a history of either incisional or excisional biopsy.
Downloads
Metrics
References
Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM, Yiangou C, Horgan K, Bundred N, Monypenny I, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst. 2006;98:599–609
. Carmon M, Olsha O, Rivkin L, Spira RM, Golomb E. Intraoperative palpation for clinically suspicious axillary sentinel lymph nodes reduces the false-negative rate of sentinel lymph node biopsy in breast cancer. Breast J. 2006;12:199–201.
. Cox C, White L, Allred N, Meyers M, Dickson D, Dupont E, Cantor A, Ly Q, Dessureault S, King J, et al. Survival outcomes in node-negative breast cancer patients evaluated with complete axillary node dissection versus sentinel lymph node biopsy. Ann SurgOncol. 2006;13:708–711.
. Naik AM, Fey J, Gemignani M, Heerdt A, Montgomery L, Petrek J, Port E, Sacchini V, Sclafani L, VanZee K, et al. The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection: a follow-up study of 4008 procedures. Ann Surg. 2004;240:462–468.
. Simmons R, Thevarajah S, Brennan MB, Christos P, Osborne M. Methylene blue dye as an alternative to isosulfan blue dye for sentinel lymph node localization. Ann SurgOncol. 2003;10:242–247.
. Eldrageely K, Vargas MP, Khalkhali I, Venegas R, Burla M, Gonzalez KD, Vargas HI. Sentinel lymph node mapping of breast cancer: a case-control study of methylene blue tracer compared to isosulfan blue. Am Surg. 2004;70:872–875
Varghese P, Mostafa A, Abdel-Rahman AT, Akberali S, Gattuso J, Canizales A, Wells CA, Carpenter R. Methylene blue dye versus combined dye-radioactive tracer technique for sentinel lymph node localisation in early breast cancer. Eur J SurgOncol. 2007;33:147–152.
McMasters KM, Tuttle TM, Carlson DJ, Brown CM, Noyes RD, Glaser RL, Vennekotter DJ, Turk PS, Tate PS, Sardi A, 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 ClinOncol. 2000;18:2560–2566
. Zahoor S, Haji A, Battoo A, Qurieshi M, Mir W, Shah M. Sentinel lymph node biopsy in breast cancer: a clinical review and update. J Breast Cancer. 2017;20(3):217–227.
. Filippakis GM, Zografos G. Contraindications of sentinel lymph node biopsy: are there any really? World Journal of Surgical Oncology. 2007;5(1):1.
. Williams NS, Bullstrode CJK, O’Connell PR. Bailey & Love’s Short Practice of Surgery. Annals of The Royal College of Surgeons of England; 2010:178
. Dogan NU, Dogan S, Favero G, Köhler C, Dursun P. The basics of sentinel lymph node biopsy: anatomical and pathophysiological considerations and clinical aspects. J Oncol. 2019;2019:1–10.
.Cserni G. Histological type and typing of breast carcinomas and the WHO classification changes over time. Pathologica. 2020;112(1):25.
Hara Y, Otsubo R, Shinohara S, et al. Lymphedema after axillary lymph node dissection in breast cancer: prevalence and risk factors—a single-center retrospective study. Lymphat Res Biol. 2022;20(6):600–606.
. Aziz HK, Azhar Y, Widarda IR, Abdurahman M, Erdiansyah Z, Nugraha P, Lukman K. Accuracy Rate of Methylene Blue Injection in Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer Patients: A Prospective Observational Study. Breast Cancer (Dove Med Press). 2023 Dec 7;15:891-897.
Singh, Nisha; Agrawal, Shuchi. Use of methylene blue dye for sentinel lymph node mapping in early-stage gynecological cancers – An option for low resource settings. Journal of Cancer Research and Therapeutics 18(4):p 1088-1092, Jul–Sep 2022.
. Azhar Y, Dewayani BM, Lukman K. Methylene blue sentinel lymph node biopsy for breast cancer learning curve in the COVID-19 era: how many cases are enough? F1000Res. 2023;11:740.
Alavifard R, Kadkhodayan S, Shandiz FH, Dabbagh VR, Sadeghi R. Is sentinel node mapping possible in surgically removed ectopic axillary breast cancer? A case report. Nucl Med Rev. 2016;19(B):29–30.
Wibisana IG. Sentinel lymph node biopsy for breast cancer using methylene blue: a new anatomical landmark involving intercostobrachial and medial pectoral nodes. Medical J Indones. 2020;29(3):298–304.
Garcia-Tejedor A, Ortega-Exposito C, Salinas S, et al. Axillary lymph node dissection versus radiotherapy in breast cancer with positive sentinel nodes after neoadjuvant therapy (ADARNAT trial). Front Oncol. 2023;13:1184021.
Cuschieri S. The STROBE guidelines. Saudi J Anaesth. 2019;13(Suppl 1):S31.
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–1457.
Cardoso F, Kyriakides S, Ohno S, et al. Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2019;30(8):1194–1220
Downloads
Published
How to Cite
Issue
Section
License

This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.