Comparable Effectiveness and Oncological Outcomes of Sentinel Lymph Node Biopsy Using Blue Dye Alone in Early-Stage...

Sentinel lymph node biopsy (SLNB) becomes the main axillary staging in early breast cancer, offering less morbidity without compromising oncological outcomes. However, resource limitations in developing countries challenge the usage of dual tracers for SLNB. Our study aimed to investigate the feasibility and oncological outcomes of SLNB using blue dye alone. The study included breast cancer patients who underwent SLNB using either isosulfan blue dye alone (S group) or dual agents (dye and radioisotope, D group) from May 2016 to May 2021 at a single institution. The SLN identification rate and oncological outcomes were compared between two groups and previous landmark studies. A total of 300 patients were enrolled in this study, with 272 (90.7%) in the S group and 28 (9.3%) in the D group. The SLN identification rate in the S group was 98.9%, comparable to the D group (100%, p = 0.745), regardless of total mastectomy or breast conserving surgery. Over a median follow-up of 64 months, rates of locoregional recurrence (1.1%, 3/270) and distant recurrence (3%, 8/270) were not significantly different between the two groups. The Kaplan-Meier curves demonstrated no significant differences in recurrence-free, breast cancer-specific, and overall survival between the S and D groups. Comparisons with results from landmark trials (ACOSOG Z0011, AMAROS, NSABP B-32) showed comparable SLN identification rates and oncological safety. Using blue dye alone for SLNB provides comparable effectiveness and survival outcomes in breast cancer patients, especially advantageous in developing countries with limited radioisotope availability.