Added value of blue dye injection in sentinel node biopsy of breast cancer patients: do all patients need blue dye?
BACKGROUND
In the current study, we evaluated the incremental value of blue dye injection in sentinel node mapping of early breast cancer patients. We specially considered the experience of the surgeons and lymphoscintigraphy results in this regard.


METHODS
605 patients with early stage breast cancer were retrospectively evaluated in the study. Patients underwent sentinel node mapping using combined radiotracer and blue dye techniques. Lymphoscintiraphy was also performed for 590 patients. Blue dye, radioisotope, and overall success rates in identifying the sentinel lymph node were evaluated in different patient groups. The benefit of blue dye and radioisotope in identifying the sentinel lymph nodes was also evaluated.


RESULTS
Marginal benefits of both blue dye and isotope for overall sentinel node detection as well as pathologically involved sentinel nodes were statistically higher in inexperienced surgeons and in patients with sentinel node visualization failure. In the patients with sentinel node visualization on lymphoscintigraphy, 6 sentinel nodes were detected by blue dye only. All these six nodes were harvested by inexperienced surgeons. On the other hand 8 sentinel nodes were detected by dye only in the patients with sentinel node non-visualization. All these nodes were harvested by experienced surgeons.


CONCLUSIONS
The use of blue dye should be reserved for inexperienced surgeons during their learning phase and for those patients in whom lymphoscintigraphy failed to show any uptake in the axilla.
Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Electronic address: sadeghir@mums.ac.ir.
Ramin
R
Sadeghi
Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Ghazaleh
G
Alesheikh
Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Seyed Rasoul
SR
Zakavi
Minimally Invasive and Endoscopic Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Asiehsadat
A
Fattahi
Minimally Invasive and Endoscopic Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Abbas
A
Abdollahi
Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Mehdi
M
Assadi
Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Ali
A
Jangjoo
Consultant Surgical Oncologist, Royal Free Hospital and University College, London, UK.
Mohammed
M
Keshtgar
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D004396:Coloring Agents; D005260:Female; D006801:Humans; D061305:Lymphoscintigraphy; D008875:Middle Aged; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
D004396:Coloring Agents; D019275:Radiopharmaceuticals
Blue dye; Breast cancer; Learning curve; Radiotracer; Sentinel node