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Updated: May 2, 2026
Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology
Published on: October 20, 2010
Evaluating Gentian Violet as a Low-Cost Alternative for Sentinel Lymph Node Biopsy in Breast Cancer: A Single-Center
Mehwish Mooghal1,2, Zakia Madad Ali1, Lubna Saleem3
1Department of Surgery, Cancer Foundation Hospital, Karachi, Sindh, Pakistan.
Background:
Sentinel lymph node biopsy (SLNB) reduces morbidity in breast cancer (BC) surgery compared to axillary lymph node dissection. Standard tracers such as vital blue dye (VBD), methylene blue (MB), and radioisotopes (RIs) are effective but costly and logistically challenging. Gentian violet (GV), a low-cost alternative, offers a potential solution for resource-constrained settings.
Methods:
We conducted a single-center retrospective study at Cancer Foundation Hospital, analyzing 40 BC patients who underwent SLNB using GV and RI (January-December 2024). Sentinel lymph node (SLN) detection rates, concordance between GV and RI, and safety profiles were assessed. Detection was compared across tumor grade, histopathology, receptors, and chemotherapy status.
Results:
The median patient age was 52 years, with most patients having a BMI between 21 and 30 (72.5%). T2 tumors were the most common (60%), followed by T3 (17.5%). Stage II disease predominated (75%), and invasive ductal carcinoma (IDC) was the most frequent histological subtype (70%). Among the cohort, 60% were estrogen/progesterone receptor-positive, 22.5% were triple-positive, and 10% were triple-negative. GV dye successfully identified SLNs in 97.5% of cases, with GV detecting more nodes than RI in 32.5% of patients, while both methods identified the same number in 50% of cases. The false-negative rate for GV was 2.5%. Detection rates were consistent across tumor subtypes, grades, and receptor statuses, with no statistically significant differences (p > 0.05). Neoadjuvant chemotherapy (NACT) did not impact SLN detection (p = 0.803). GV dye exhibited a favorable safety profile, with no intraoperative or postoperative complications reported at Days 0, 3-7, and 30. No cases of staining-related reactions, dermatitis, tattooing, or skin necrosis were observed.
Conclusions:
Gentian violet is a safe, effective, and affordable alternative to MB for SLNB in BC. It demonstrates high detection rates and excellent safety, particularly suitable for resource-limited settings. Larger studies are warranted to validate these findings and support broader clinical adoption.
