title: Three stage axillary lymphatic massage optimizes sentinel lymph node localisation using blue dye.
abstract: OBJECTIVE
  This paper describes a simple technique of axillary and breast massage which improves the successful identification of blue sentinel nodes using patent blue dye alone.
  
  
  METHODS
  Patent blue dye was injected in the subdermal part of the retroaroelar area in 167 patients having surgical treatment for invasive breast cancer. Three stage axillary lymphatic massage was performed prior to making the axillary incision for sentinel lymph node biopsy. All patients had completion axillary sampling or clearance.
  
  
  RESULTS
  A blue lymphatic duct leading to lymph nodes of the first drainage was identified in 163 (97%) of the patients. Results are compared with 168 patients who had sentinel lymph node biopsy using blue dye without axillary massage. Allergic reactions were observed in four patients (1.2%).
  
  
  CONCLUSIONS
  Three stage axillary lymphatic massage improves the successful identification of a blue sentinel lymph node in breast cancer patients.
authors.affiliation: Breast Unit, University Hospital of North Staffordshire, Keele University, Stoke-on-Trent, UK. drabdulbasit@aol.com.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kirby
authors.forename: Abdul
authors.initials: A
authors.lastname: Basit
authors.forename: Quang T
authors.initials: QT
authors.lastname: Nguyen
authors.forename: Anthony
authors.initials: A
authors.lastname: Jaipersad
authors.forename: Rebecca
authors.initials: R
authors.lastname: Billingham