title: Macroscopic quality control improves the reliability of blue dye-only sentinel lymph node biopsy in breast cancer.
abstract: BACKGROUND
  One of the problems of sentinel lymph node (SLN) biopsy is the risk of false negatives. At the Institut Curie, to reduce the false-negative rate, we have developed a histological quality control of the SLN performed by blue dye alone, which consists of verification of the SLN blue stain by the pathologist.
  
  
  METHODS
  A total of 324 patients underwent an SLN biopsy procedure with patent blue dye only followed by an immediate axillary dissection. Initially, SLNs were checked to ensure that they were blue by macroscopic examination. Finally, a search for immunohistochemistry micrometastasis was performed.
  
  
  RESULTS
  In 277 (85.5%) of 324 patients, an SLN was identified by the surgeon. After standard examination, the false-negative rate was 11.1% (10 of 90). After macroscopic checking of the 197 negative SLNs, 167 of the 197 were confirmed blue, and there were 5 false negatives, which brought the false-negative rate down to 5.6% (5 of 90). Sixty SLNs out of the 167 confirmed blue SLNs were then proved to be immunohistochemically micrometastatic, and there were 3 false negatives, giving a final false-negative rate of 2.2% (2 of 90; P =.002).
  
  
  CONCLUSIONS
  In this series, the procedure of pathologic analysis of the SLN has resulted in a significant reduction of the false-negative rate.
authors.affiliation: Department of Surgery, Institut Curie, Paris, France. claude.nos@curie.net
authors.forename: Claude
authors.initials: C
authors.lastname: Nos
authors.forename: Paul
authors.initials: P
authors.lastname: Fréneaux
authors.forename: Christine
authors.initials: C
authors.lastname: Louis-Sylvestre
authors.forename: Jeremy S
authors.initials: JS
authors.lastname: Hurren
authors.forename: Denis
authors.initials: D
authors.lastname: Heitz
authors.forename: Xavier
authors.initials: X
authors.lastname: Sastre-Garau
authors.forename: Krishna B
authors.initials: KB
authors.lastname: Clough
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D004396:Coloring Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D021701:Sentinel Lymph Node Biopsy / Q000379:methods* / Q000592:standards*
chemical_list: D004396:Coloring Agents