Sentinel lymph node biopsy in early breast carcinoma using fluorescein sodium and methylene blue dye: A validation study

Chandan Kumar Jha ¹, Upasna Sinha ², Prashant Kumar Singh ³

⁰Associate Professor, Department of General Surgery (Endocrine Surgery), All India Institute of Medical Sciences, Patna, India.

Tropical Doctor +

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July 23, 2024

View abstract on PubMed

Summary

For breast cancer patients, fluorescein sodium combined with methylene blue dye offers an alternative for sentinel lymph node biopsy (SLNB) when radioisotopes are unavailable. This combination shows acceptable identification rates but adding fluorescein provides no extra benefit.

Area Of Science

Oncology
Surgical Pathology
Medical Imaging

Background

Radioisotope availability for sentinel lymph node biopsy (SLNB) is limited in low- and middle-income countries.
There is a need for alternative, reliable tracers for SLNB in breast carcinoma.
Methylene blue dye (MBD) and fluorescein sodium (FS) are potential alternatives.

Purpose Of The Study

To validate the effectiveness of fluorescein sodium (FS) combined with methylene blue dye (MBD) for SLNB in node-negative early breast carcinoma.
To assess the sentinel lymph node (SLN) identification rate and false negative rate of MBD, FS, and the combination (MBD + FS).

Main Methods

Prospective cross-sectional study.
Patients with node-negative early breast carcinoma underwent SLNB using FS and MBD.
Axillary dissection was performed post-SLNB to validate results.
SLN identification and false negative rates were assessed for MBD alone, FS alone, and the MBD + FS combination.

Main Results

The combination of MBD and FS achieved an acceptable SLN identification rate.
The addition of FS to MBD did not significantly improve the SLN identification rate compared to MBD alone.
False negative rates were assessed for all tracer combinations.

Conclusions

Sentinel lymph node biopsy using a combination of fluorescein sodium and methylene blue dye is a viable option in resource-limited settings.
Fluorescein sodium does not offer additional benefit when used with methylene blue dye for SLNB in breast cancer.
Further research may be needed to optimize non-radioisotope tracers for SLNB.

Keywords:

Sentinel lymph node biopsy early breast cancer fluorescein sodium methylene blue node-negative breast cancer