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> Sentinel Lymph Node Biopsy Using a Blue Dye Technique Alone Leads to a High False-Negative Rate, Ryzyko falszywie negatywnego testu wezla wartownika
27.06.2007, 20:22

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Sentinel Lymph Node Biopsy Using a Blue Dye Technique Alone Leads to a High False-Negative Rate: Presented at ESSO
By Chris Berrie

VENICE, ITALY -- December 5, 2006 -- Use of blue dye sentinel lymph node biopsy (SLNB) alone provides satisfactory identification rates in patients with conservable invasive breast cancers, but its use as an isolated technique cannot be advocated due to the unacceptably high false-negative rate, researchers reported here at the 13th Congress of the European Society of Surgical Oncology (ESSO).

The prospective study was presented on November 30th by co-investigator Owen J. Greene, MRCS, surgical trainee, department of pediatric surgery, York Hill Children's Hospital, Glasgow, United Kingdom.

"Axillary node status is the most important prognostic indicator in patients with invasive breast cancer," he said, "and sentinel lymph node biopsy is used to identify the first lymph node(s) in the regional lymphatic basin into which the lymph nodes of the breast drain."

Today, the procedure is generally performed for patients with small invasive breast cancer and with clinically node-negative axilla, and there are several methods of minimally invasive axillary staging available: axillary sampling alone (4-node); blue dye SLNB alone; radioisotope SLNB alone; dual radioisotope and blue dye SLNB; and axillary sampling and blue dye SLNB combined.

While dual radioisotope and blue dye SLNB is usually advocated, particularly in the UK, this can be problematic due to the need for further training and licensing for the use of radioisotopes.

"Despite extensive publications in the field of minimally invasive axillary staging for breast cancer, there is still continued debate over the safest and best technique available, in particular when considering identification rates and false-negative rates," Greene said.

To compare blue dye SLNB alone with blue dye SLNB plus axillary sampling, Greene and colleagues enrolled 219 consecutive patients with clinically node-negative axillas (mainly T1 tumours, <2 cm in size) who were detected through screening and were treated with conservation surgery at the Western Infirmary in Glasgow.

The procedure followed the standardised sample method of subdermal, periareolar injection of 2 mL of Patent V blue dye followed by excision of all blue lymph nodes plus any palpable, suspicious, non-blue lymph nodes. A minimum total sample of 4 lymph nodes was accepted, including those blue and non-blue.

Of the 219 axillas sampled, with at least 1 blue dye SLNB identified in 211 of axillas, the non-blue dye identified a further 8, giving an identification rate for blue dye SLNB of 96.4%. With the mean numbers of axillary, blue and non-blue lymph nodes of 4.9, 2.0 and 2.8, respectively, 32 of 219 axilla samples contained a positive lymph node, giving a node-positive rate of 14.6%.

Of the 32 lymph-node-positive axillas, 24 were blue lymph node positives; 8 non-blue lymph nodes were positive for metastatic disease in the axillary sample, producing a false-negative rate of 25.0%.

Despite the satisfactory identification rates that were obtained with blue dye SLNB alone, this was accompanied by an unacceptable high false-negative rate, Greene said. Thus, the use of blue dye SLNB as an isolated technique cannot be advocated, and should continue to be used in combination with either axillary sampling or isotope nucleotide scanning, he added.

"Injection of blue dye is not without its complications, principally anaphylaxis, allergy and nipple staining," he said, and noted that it remains to be determined whether the addition of blue dye in minimally invasive axillary staging of small, clinically node-negative breast cancers is actually necessary.

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