Peri-Areolar Administration of Methylene Blue Dye as an Independent, Cost Effective and Reliable Technique for Sentinel Lymph Node Biopsy in Early Breast Cancer

Joseph Sushil Rao and Rakesh Ramesh

Department of Surgical Oncology, St. John’s Medical College Hospital, India

^*Correspondance to: Rakesh Ramesh 

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Abstract:

Background: Sentinel Lymph Node (SLN) biopsy is the standard technique of pathologically staging a clinically negative axilla for decisions on adjuvant treatment. Multiple techniques and materials can be used to identify sentinel lymph nodes, of which, Blue Dye or Radio isotopes are commonly used. Due to high costs of radioisotope techniques, dyes are preferred in the underdeveloped countries. Studies demonstrate dye techniques being equally effective when compared to radioisotopes. In our study, we analyze the efficacy of Methylene Blue for identifying the SLN in clinically negative axilla of early breast cancer patients and determine the best site of administration for superior identification rates.Methodology: The prospective study between May 2015 to April 2016 comprised of 40 newly diagnosed early breast cancer patients undergoing treatment in the Department of Surgical Oncology of a tertiary medical center in South India. Following Institutional Ethical Committee clearance and informed consent, 3 ml of 1% Methylene Blue was injected in the peri-areolar/peri-tumor area of the affected breast. The SLN was identified intra-operatively, and the data was statistically analyzed using SPSS version 24.Results: Accuracy of identifying the SLN was 94.7% with a false negative rate of 5.26%. The technique demonstrated a sensitivity and specificity of 89% and 100% respectively with a positive predictive value of 100% and negative predictive value of 93.3%. The Identification Rate of Peri-areolar administration (96%) was significantly (0.003) superior to the Peri-tumoralsite (79%).Conclusion: The high accuracy rate with low false negative rate of Methylene Blue suggests a reliable alternative to radioisotopes or a combination of Radioisotopes and Dye techniques for the detection of SLN biopsies in early breast cancer patients with clinically negative axilla. The Peri-areolar route of administration should be used to attain better results and higher efficacy rates.

Keywords:

Early Breast Cancer; Sentinel Lymph Node; Methylene Blue Dye

Cite the Article:

Rao JS, Ramesh R. Peri-Areolar Administration of Methylene Blue Dye as an Independent, Cost Effective and Reliable Technique for Sentinel Lymph Node Biopsy in Early Breast Cancer. Clin Oncol. 2019; 4: 1568.