title: Evaluation of the gamma probe guided sentinel lymph node biopsy and the blue dye technique in the management of breast cancer.
abstract: The aim of this study was to evaluate the efficacy of lymphoscintigraphy, gamma probe guided sentinel lymph node biopsy (GP-SLNB) in the management of breast cancer and study the follow-up results. Fifty two patients (mean age 47.28+/-9.7; range 23-69yr) with operable breast carcinoma and clinically negative axilla were studied. Scintigraphy for the detection of SLN was performed 2-4h before surgery by injecting technetium-99m labeled nanocolloid intradermally in the peritumoral region. First lymph node (LN) to appear on the scan was labeled as SLN and by using the GP was marked on the skin. Blue dye was also injected in all patients intraoperatively and hot and/or blue LN were studied in the axilla using the GP. The SLN was identified in 50 patients (96% success rate) while in 2 patients SLN was not visualized on imaging. The blue dye successfully localized SLN in 45/52 (87%) of the cases. Of the 52 patients, 16 had axillary lymph node dissection (ALND), including 14 SLNB positive for lymph node metastases cases and the two cases in which no SLN was imaged. In the remaining 36/52 cases SLN were negative for metastases and patients on the follow-up remained disease free (NPV 100% for a follow-up period of 12-36 months). The success rate, sensitivity, negative predictive value, and accuracy were 96%, 93%, 100%, and 98% using the GP-SLNB, 87%, 80%, 100%, and 93% using blue dye, and 98%, 100%, 100%, and 98% using combined methods, respectively. In conclusion, lymphoscintigraphy, GP-SLNB has a higher success rate and sensitivity versus the dye technique and when combined with the blue dye technique its sensitivity increases to 100%. We found a high negative predictive value for SLNB and the recurrence rate in these negative SLNB was comparable to the ALND.
authors.affiliation: Department of Nuclear Medicine, Hussain Makki Al Jumma Centre for Specialized Surgery, 83001 Khaitan, Kuwait. dr_shajji@yahoo.com
authors.forename: Sharjeel
authors.initials: S
authors.lastname: Usmani
authors.forename: Haider Ali
authors.initials: HA
authors.lastname: Khan
authors.forename: Fawaz
authors.initials: F
authors.lastname: abu Huda
authors.forename: Najeeb
authors.initials: N
authors.lastname: Ahmed
authors.forename: Naheel
authors.initials: N
authors.lastname: al Nafisi
authors.forename: Fahad
authors.initials: F
authors.lastname: Marafi
authors.forename: Shihab
authors.initials: S
authors.lastname: al Mohannadi
authors.forename: Amir
authors.initials: A
authors.lastname: Javed
authors.forename: Henney G
authors.initials: HG
authors.lastname: Amanguno
authors.forename: Noha
authors.initials: N
authors.lastname: Al Saleh
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D002277:Carcinoma / Q000175:diagnosis* / Q000556:secondary*; D004396:Coloring Agents; D005260:Female; D006801:Humans; D008875:Middle Aged; D011877:Radionuclide Imaging / Q000379:methods*; D015203:Reproducibility of Results; D012394:Rosaniline Dyes; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D012394:Rosaniline Dyes; C025484:iso-sulfan blue