title: 1% lymphazurin vs 10% fluorescein for sentinel node mapping in colorectal tumors.
abstract: OBJECTIVE
  Ten percent fluorescein may be successfully used as an alternative to 1% Lymphazurin (1% isosulfan blue; US Surgical Corp, North Haven, Conn) in sentinel lymph node (SLN) mapping for the accurate staging of colorectal tumors.
  
  
  METHODS
  Review of prospectively gathered data.
  
  
  METHODS
  University-affiliated regional medical center.
  
  
  METHODS
  Sentinel lymph node mapping was performed in 120 consecutive patients with colorectal malignancies.
  
  
  METHODS
  The first 1 to 4 blue nodes detected within 5 minutes were designated as Lymphazurin-detected SLNs. The first 1 to 4 fluorescent nodes seen under the Wood light were designated as fluorescein-detected SLNs. Multilevel serial sections for hematoxylin-eosin and immunohistochemistry studies for cytokeratin were performed on all SLNs.
  
  
  METHODS
  Successful mapping, accuracy, skip metastasis, adverse reactions, occult micrometastases detection, and cost.
  
  
  RESULTS
  Mapping was successful using Lymphazurin in 99% of the patients vs 97% of the patients using fluorescein (P =.89). The accuracy of predicting nodal metastases with each tracer was 95.8% vs 93.1%, respectively (P =.82). The skip metastases rate was 4.2% for Lymphazurin vs 6.9% for fluorescein (P =.37). The 5 patients in whom nodal disease was only identified as occult micrometastasis in the SLNs had a total of 5 SLNs, all of which were identified by both tracers. No adverse reactions occurred. The cost for Lymphazurin was $99.00, while the cost for fluorescein was $2.10.
  
  
  CONCLUSIONS
  With the exception of cost, there were no statistically significant differences between the 2 dyes. While easy availability and lower cost remain distinct advantages of fluorescein, Lymphazurin remains the gold standard. In patients with known hypersensitivity to Lymphazurin and when availability and cost are an issue, fluorescein may be used effectively for SLN mapping in colorectal tumors.
authors.affiliation: Department of Surgery, Michigan State University, McLaren Regional Medical Center, Flint, USA.
authors.forename: Adrian G
authors.initials: AG
authors.lastname: Dan
authors.forename: Sukamal
authors.initials: S
authors.lastname: Saha
authors.forename: Keith M
authors.initials: KM
authors.lastname: Monson
authors.forename: David
authors.initials: D
authors.lastname: Wiese
authors.forename: Elie
authors.initials: E
authors.lastname: Schochet
authors.forename: Kimberly R
authors.initials: KR
authors.lastname: Barber
authors.forename: Balvant
authors.initials: B
authors.lastname: Ganatra
authors.forename: Delip
authors.initials: D
authors.lastname: Desai
authors.forename: Sunil
authors.initials: S
authors.lastname: Kaushal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D019793:Fluorescein; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
chemical_list: D003287:Contrast Media; D012394:Rosaniline Dyes; C025484:iso-sulfan blue; D019793:Fluorescein