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The Application of 1% Methylene Blue Dye As a Single Technique in Breast Cancer Sentinel Node Biopsy
Published on: June 1, 2019
Axillary sentinel node biopsy after neoadjuvant chemotherapy
V Ozmen1, E S Unal, M E Muslumanoglu
1Department of General Surgery, Istanbul University, Istanbul College of Medicine, The Breast Unit, Capa, Istanbul 34390, Turkey. vozmen@istanbul.edu.tr
Summary
Sentinel lymph node biopsy (SLNB) is effective for locally advanced breast cancer (LABC) patients with initially positive nodes that become negative after neoadjuvant chemotherapy (NAC). Accuracy is influenced by residual tumor size and initial nodal status.
Area of Science:
- Oncology
- Surgical Oncology
- Breast Cancer Research
Background:
- The utility of sentinel lymph node biopsy (SLNB) in locally advanced breast cancer (LABC) patients with axillary lymph nodes that appear clear after neoadjuvant chemotherapy (NAC) is not well-defined.
- Assessing axillary lymph node status is critical for staging and treatment planning in LABC.
Purpose of the Study:
- To evaluate the accuracy and identify factors influencing sentinel lymph node biopsy (SLNB) outcomes in LABC patients.
- To determine the false-negative rate and predictors of non-sentinel lymph node metastasis after NAC.
Main Methods:
- Retrospective analysis of 77 LABC patients who underwent SLNB (blue-dye and radioisotope) after NAC rendered axillary nodes clinically negative.
- Investigated factors affecting SLN identification, false-negative rates, and non-SLN metastasis.
Main Results:
- SLNB identification rate was 92%, with 90% accuracy and a 13.7% false-negative rate.
- Decreased SLN identification was associated with residual tumor size >2 cm (p=0.002).
- Higher false-negative rates correlated with N2 nodal status before NAC (p=0.04).
- Multifocal/multicentric tumors (p=0.003), lymphovascular invasion (p=0.0001), residual tumor >2 cm (p=0.004), and extra-sentinel node extension (p=0.002) predicted non-SLN metastasis.
Conclusions:
- SLNB is feasible in LABC patients with clinically node-negative axillae post-NAC, offering high identification and acceptable false-negative rates.
- SLNB accuracy is impacted by residual tumor size and baseline nodal status.
- Predictors for additional non-SLN involvement include tumor multifocality, lymphovascular invasion, larger residual tumor size, and extra-sentinel node spread.
