Optimization of sentinel lymph node identification techniques in the Indian setting: A randomized clinical trial

Area of Science:

• Oncology
• Surgical Pathology
• Medical Imaging

Background:

• Sentinel lymph node biopsy (SLNB) is standard for breast cancer staging.
• Traditional SLNB uses blue dye and radiotracer, but availability is limited in India.
• Patent blue violet (PBV) is often unavailable or costly in resource-limited settings.

Purpose of the Study:

• To compare the efficacy of methylene blue (MB) versus PBV for sentinel lymph node identification in breast cancer.
• To evaluate SLNB techniques in the Indian context with limited resources.

Main Methods:

• A randomized control trial compared MB and PBV in combination with radiotracer for SLNB.
• 119 patients received MB mapping and 118 received PBV mapping.
• Axillary lymph node-negative breast cancer patients were included; frozen section was performed.

Main Results:

• SLN identification rates were high and comparable: 97.4% for MB and 96.6% for PBV.
• Concordance with axillary lymph node dissection was excellent for both dyes.
• MB demonstrated a lower false-negative proportion (2.56%) compared to PBV (7.69%).
• MB is significantly more cost-effective than PBV (INR 15 vs. INR 8190 per dose).

Conclusions:

• Methylene blue (MB) is a viable and effective alternative to PBV for SLNB.
• MB offers comparable efficacy and improved cost-effectiveness, making it suitable for low-resource settings.
• SLNB using MB can be recommended as the technique of choice in resource-limited environments.