title: Is blue dye still required during sentinel lymph node biopsy for breast cancer?
abstract: BACKGROUND
  In early breast cancer, the optimal technique for sentinel lymph node biopsy (SLNB) is the combined technique (radioisotope and Patent Blue V) which achieves high identification rates. Despite this, many centres have decided to stop using blue dye due to blue-dye-related complications (tattoo, anaphylaxis). We evaluated the SLNB identification rate using the combined technique with and without Patent Blue V and the blue-dye-related complication rates.
  
  
  METHODS
  Clinical and histological data were analysed on patients undergoing SLNB between March 2014 and April 2015. SLNB was performed following standard hospital protocols using the combined technique.
  
  
  RESULTS
  A total of 208 patients underwent SLNB and 160 patients (342 nodes) with complete operation notes were available for final analysis. The identification rate with the combined technique was 98.8% (n= 158/160), with blue dye alone 92.5% (n= 148/160) and with radioisotope alone 97.5% (n= 156/160). A total of 76.9% (263/342) of nodes were radioactive and blue, 15.5% (53/342) only radioactive and 2.3% (8/342) only blue, 5.3% (18/342) were neither radioactive nor blue. No anaphylactic reactions were reported and blue skin staining was reported in six (3.8%) patients.
  
  
  CONCLUSIONS
  The combined technique should continue be the preferred technique for SLNB and should be standardised. Radioisotope alone (but not blue dye alone) has comparable sentinel node identification rates in experienced hands. National guidelines are required to optimise operative documentation.
authors.affiliation: Division of Cancer Studies, King's College London, Guy's Hospital Campus, Great Maze Pond, London SE1 9RT, UK; Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK.
authors.forename: Mirjam Cl
authors.initials: MC
authors.lastname: Peek
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK.
authors.forename: Tibor
authors.initials: T
authors.lastname: Kovacs
authors.affiliation: School of Business, 612, Maxwell Bldg, University of Salford, Salford M5 4WT, UK.
authors.forename: Rose
authors.initials: R
authors.lastname: Baker
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK.
authors.forename: Hisham
authors.initials: H
authors.lastname: Hamed
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK.
authors.forename: Ash
authors.initials: A
authors.lastname: Kothari
authors.affiliation: Division of Cancer Studies, King's College London, Guy's Hospital Campus, Great Maze Pond, London SE1 9RT, UK; Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Douek
keywords: breast cancer; patent blue; radioisotope; sentinel lymph node biopsy