title: Can we use frozen section analysis of sentinel lymph nodes mapped with methylene blue dye for decision making upon one-time axillary dissection in breast carcinoma surgery in developing countries?
abstract: OBJECTIVE
  To evaluate the accuracy of intraoperative frozen section analysis (FSA) of sentinel lymph nodes (SLNs) mapped using methylene blue dye (MBD) and its usefulness for selecting patients with breast carcinomas and positive axillary lymph nodes (ALNs) for one-time axillary dissection.
  
  
  METHODS
  152 female patients with T1/T2 breast carcinomas and clinically negative ALNs were selected for mapping using MBD (1%) from October 2010 to December 2011. Patients underwent FSA of mapped SLNs and ALN dissection. The accuracy of SLN-FSA was tested by comparing these findings with the definite histopathology (HP) of SLNs, as well as of other ALNs. Sensitivity, specificity, positive and negative predictive values were calculated.
  
  
  RESULTS
  There was a 98%-match between FSA and definite HP findings of SLNs, suggesting high accuracy of FSA in this series. None of 3 patients with false-negative SLNs on FSA had additional axillary nodal metastases. One out of 20 (5%) patients with metastases in other ALNs had "clear" SLNs, both on FSA and definite HP (false-negative). Accuracy reached 94.1%.
  
  
  CONCLUSIONS
  SLN-FSA enables adequate selection of patients for one-time axillary node dissection. MBD mapping technique is cheap, feasible and enables easy and precise detection of the first draining ALNs. Using FSA of SLNs mapped with MBD, patients with breast carcinoma benefit from complete surgical treatment during one hospitalization, the risk of undergoing anaesthesia twice is reduced, as well as the treatment cost, which is important in developing countries.
authors.affiliation: Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia.
authors.forename: Igor
authors.initials: I
authors.lastname: Djurisic
authors.forename: Nada
authors.initials: N
authors.lastname: Santrac
authors.forename: Marko
authors.initials: M
authors.lastname: Buta
authors.forename: Merima
authors.initials: M
authors.lastname: Oruci
authors.forename: Ivan
authors.initials: I
authors.lastname: Markovic
authors.forename: Srdjan
authors.initials: S
authors.lastname: Nikolic
authors.forename: Milan
authors.initials: M
authors.lastname: Zegarac
authors.forename: Radan
authors.initials: R
authors.lastname: Dzodic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D003657:Decision Making; D003906:Developing Countries; D005260:Female; D005629:Frozen Sections; D006801:Humans; D008197:Lymph Node Excision; D008751:Methylene Blue; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy
chemical_list: D008751:Methylene Blue