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The Application of 1% Methylene Blue Dye As a Single Technique in Breast Cancer Sentinel Node Biopsy
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Sentinel lymph node biopsy in medullary thyroid microcarcinomas.

Nada Santrac1, Ivan Markovic1,2, Natasa Medic Milijic3

  • 1Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, 11000, Serbia.

Endocrine Journal
|December 6, 2019
PubMed
Summary

Sentinel lymph node biopsy using methylene blue dye accurately detects lateral metastases in medullary microcarcinomas. This method optimizes surgery by identifying patients needing lateral dissection, avoiding unnecessary procedures.

Keywords:
Calcitonin below 1,000Lateral neck dissectionMedullary thyroid microcarcinomaMethylene blue dyeSentinel lymph node biopsy

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Area of Science:

  • Oncology
  • Surgical Pathology
  • Nuclear Medicine

Background:

  • Medullary microcarcinomas require precise staging for effective treatment.
  • Accurate detection of lateral lymph node metastases is crucial for surgical planning.
  • Current methods may lead to overtreatment or undertreatment of lateral disease.

Purpose of the Study:

  • To evaluate the accuracy of sentinel lymph node biopsy (SLNB) with methylene blue dye.
  • To assess its utility for intraoperative detection of lateral metastases in medullary microcarcinomas.
  • To select patients for targeted lateral dissection, optimizing surgical extent.

Main Methods:

  • Prospective study involving 20 patients with clinically N0M0 medullary microcarcinomas.
  • Bilateral SLNB using methylene blue dye after total thyroidectomy and central neck dissection.
  • Intraoperative frozen section analysis of sentinel nodes to guide lateral dissection decisions.

Main Results:

  • 100% sentinel lymph node identification rate with no allergic reactions to methylene blue.
  • Frozen section findings perfectly matched final pathology, with no skip metastases.
  • The SLNB method demonstrated 100% sensitivity, specificity, and accuracy.
  • 10% of clinically node-negative patients were reclassified as node-positive (pN1b).

Conclusions:

  • Sentinel lymph node biopsy with methylene blue dye is a highly accurate method for intraoperative assessment of lateral lymph node involvement.
  • This technique enables precise selection of patients requiring lateral dissection, optimizing surgical management for medullary microcarcinomas.
  • It allows for less extensive surgery in node-negative patients, reducing morbidity.