title: Limited effectiveness of patent blue dye in addition to isotope scanning for identification of sentinel lymph nodes: Cross-sectional real-life study in 1024 breast cancer patients.
abstract: BACKGROUND
  Although morbidity is reduced when sentinel lymph node (SLN) biopsy is performed with dual isotopic and blue dye identification, the effectiveness of adding blue dye to radioisotope remains debated because side effects including anaphylactic reactions.
  
  
  METHODS
  Using data from a prospectively maintained database, 1884 lymph node-negative breast cancer patients who underwent partial mastectomy with SLN mapping by a dual-tracer using patent blue dye (PBD) and radioisotope were retrospectively studied between January 2000 and July 2013. Patients with tumors <3 cm and with >1 node detected by one of the two techniques (N = 1024) were included in this real-life cross-sectional study.
  
  
  RESULTS
  Among the 1024 patients, 274 had positive SLN detected by isotopic and/or PBD staining. Only 4 patients having no detectable radioactivity in the axilla had SLN identified only by PBD staining (blue-only) while 26 patients had SLN only identified by isotopic detection (hot-only) illustrating failure rates of 9.5% (26/274) and 1.5% (4/274), respectively. Among these four patients, two had negative lymphoscintigraphy. Therefore, the contribution of PBD to metastatic nodes identification was relevant for only 2/274 patients (0.8%). Three patients (0.3%) had an allergic reaction with PBD, and anaphylactic shock occurred in two cases (0.2%).
  
  
  CONCLUSIONS
  The added-value of PBD to reduce the false-negative rate of SLN mapping is only limited to the rare cases in which no radioactivity is detectable in the axilla (<1%). When a radioisotope mapping agent is available, the use of PBD should be avoided, because it can induce anaphylaxis.
authors: Département de Chirurgie, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France. Electronic address: p.rauch@nancy.unicancer.fr.
authors: Philippe
authors: P
authors: Rauch
authors: Université de Lorraine, Nancy, France; CNRS UMR7039, CRAN Université de Lorraine, Vandoeuvre-les Nancy, France; Service de Biopathologie, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France.
authors: Jean-Louis
authors: JL
authors: Merlin
authors: Département de Chirurgie, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France.
authors: Lea
authors: L
authors: Leufflen
authors: Cellule Data Biostatistics, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France.
authors: Julia
authors: J
authors: Salleron
authors: Université de Lorraine, Nancy, France; CNRS UMR7039, CRAN Université de Lorraine, Vandoeuvre-les Nancy, France; Service de Biopathologie, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France.
authors: Alexandre
authors: A
authors: Harlé
authors: Université de Lorraine, Nancy, France; Département de Médecine Nucléaire, CHU Nancy, Vandoeuvre-les-Nancy, France.
authors: Pierre
authors: P
authors: Olivier
authors: Département de Chirurgie, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France; Université de Lorraine, Nancy, France; CNRS UMR7039, CRAN Université de Lorraine, Vandoeuvre-les Nancy, France.
authors: Frédéric
authors: F
authors: Marchal
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D004396:Coloring Agents; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy; D008408:Mastectomy; D008875:Middle Aged; D011868:Radioisotopes; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging*; D021701:Sentinel Lymph Node Biopsy / Q000379:methods
chemical_list: D004396:Coloring Agents; D011868:Radioisotopes; D019275:Radiopharmaceuticals
keywords: Breast cancer; Patent blue dye; Radioisotopic detection; SLN mapping; Sentinel lymph node