Validation sentinel lymph node biopsy study in cN0 axilla using low-cost dual dye technique: potential solution for...

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Management

Background:

• Sentinel lymph node biopsy (SLNB) is the standard for axillary staging in node-negative breast cancer.
• High costs and limited availability of radiopharmaceuticals hinder SLNB in developing countries.
• This study explores fluorescein-guided SLNB with methylene blue dye as a cost-effective alternative.

Purpose of the Study:

• To evaluate the feasibility of sentinel lymph node identification (SLN-IR) using fluorescein-guided SLNB combined with methylene blue dye (MBD).
• To assess the efficacy of this dual-dye approach in early breast cancer patients, including those who received neoadjuvant chemotherapy (NACT).

Main Methods:

• A prospective, cross-sectional, non-randomized validation study was conducted.
• Patients with clinically node-negative axillae underwent SLNB using fluorescein (with blue LED light) and MBD.
• Axillary dissection was performed regardless of SLNB histology; SLN-IR and False Negative Rate (FNR) were assessed.

Main Results:

• SLNs were identified in 96.6% of pre-chemotherapy patients and 82% of post-NACT patients.
• Combined MBD and fluorescein dye achieved a 96.7% SLN-IR in pre-chemotherapy and 82% in post-NACT patients.
• FNRs were 7.4% (pre-NACT) and 8.7% (post-NACT) for the combined dual-dye method.

Conclusions:

• Low-cost dual dyes (fluorescein and MBD) provide adequate SLN-IR and FNR for early breast cancer staging in resource-limited settings.
• SLNB in post-NACT axilla is viable but shows reduced identification rates and warrants further evaluation.