Mastering Low-Cost Sentinel Lymph Node Biopsy using Fluorescein Sodium and Methylene Blue Dye: Evaluating its...

Sentinel lymph node biopsy (SLNB) has become the standard of care for patients with clinically negative axillary lymph node in patients with breast cancer. Low-cost dual dye technique using Fluorescein sodium and Methylene Blue Dye (FS + MBD) is particularly suitable for low-resource settings and surgeons using this must progress up a learning curve in order to ensure quality and safety equivalent to conventional SLNB. Learning curve of conventional SLNB has been evaluated; however, it has not been studied for FS + MBD. This prompted us to prospectively evaluate the learning curve for SLNB using FS + MBD. Identification rate of Sentinel lymph nodes, false negative rates, post operative morbidity were calculated for initial 100 consecutive cases for a single surgeon in a Tertiary teaching center in central India. The identification rate improved to 92% after patient number 20 and false negative rate was less than 7%. Post-operative axillary morbidity (12%) included seromas and no abscess. SLNB with FSD + MBD is associated with a learning curve which is steeper than that of conventional technique and its successful adoption requires surgeons to recognize and navigate this learning curve to optimize identification rates and reduce false negatives.