Determining Accurate Dye Combinations for Sentinel Lymph Node Detection: A Systematic Review

Mark Swerdlow ^1,2, Kella L Vangsness ¹, Gavin T Kress ^1,2

⁰From the Division of Plastic Surgery, City of Hope National Medical Center, Duarte, Calif.

Plastic and Reconstructive Surgery. Global Open +

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February 9, 2024

View abstract on PubMed

Summary

Combining lymphatic dyes significantly improves sentinel lymph node (SLN) detection accuracy in cancer staging. Dye combinations offer superior results compared to single dyes, enhancing diagnostic capabilities for tumor spread.

Area Of Science

Oncology
Surgical Pathology
Medical Imaging

Background

Lymphatic mapping using dyes is crucial for identifying tumor spread to lymph nodes.
The combination of blue dye and technetium-99 is the current gold standard for sentinel lymph node biopsy (SLN).
Various lymphatic dyes and combinations exist, but their detection efficacy varies.

Purpose Of The Study

To systematically review and compare the accuracy of different lymphatic dyes and combinations for sentinel lymph node detection.
To identify optimal dye combinations for improved SLN biopsy outcomes.

Main Methods

A systematic review of major scientific databases (PubMed, SCOPUS, Web of Science, Medline) was conducted.
Search terms included various lymphatic dyes, dye combinations, and cancer-related procedures like sentinel lymph node biopsy.
34 studies, evaluating 89 methods with 22 unique tracers across 12,801 SLNs, were included in the analysis.

Main Results

Dye accuracy in SLN detection ranged from 69.8% to 100%.
Five specific dye combinations achieved 100% accuracy in identifying sentinel lymph nodes.
Dye combinations demonstrated higher accuracy than single-dye applications.

Conclusions

Combining lymphatic dyes enhances sentinel lymph node detection rates.
Indocyanine green (ICG) may serve as a viable alternative to technetium-99, potentially increasing accessibility to SLN procedures.
The ideal tracer should be cost-effective, visualize well without special equipment, and have no adverse effects.