title: Methylene blue dye as an alternative to isosulfan blue dye for sentinel lymph node localization.
abstract: 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 (99m)Tc-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.
authors.affiliation: Department of Surgery, New York Presbyterian Hospital, the Weill Cornell Medical College, New York, New York 10021, USA. rms2002@med.cornell.edu
authors.forename: Rache
authors.initials: R
authors.lastname: Simmons
authors.forename: Sarmela
authors.initials: S
authors.lastname: Thevarajah
authors.forename: Meghan B
authors.initials: MB
authors.lastname: Brennan
authors.forename: Paul
authors.initials: P
authors.lastname: Christos
authors.forename: Michael
authors.initials: M
authors.lastname: Osborne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D004791:Enzyme Inhibitors; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008751:Methylene Blue; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012394:Rosaniline Dyes; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
chemical_list: D004791:Enzyme Inhibitors; D012394:Rosaniline Dyes; C025484:iso-sulfan blue; D008751:Methylene Blue