Abstract
Abstract Abstract #4140 Background: Isosulfan blue has proven invaluable for sentinel lymph node identification in breast cancer. However, an intermittent supply shortage of this agent over the last few years has led to alternative usage of methylene blue. Worldwide, methylene blue is traditionally viewed as a less expensive and safer equivalent to isosulfan, with few reports of significant side effects. Its increased usage has led to anecdotal reports of local skin reactions. This study serves to review the rate of local complications observed following subareolar infiltration of methylene blue for sentinel lymph node identification in breast cancer staging.
 Material Methods: This is a retrospective review of prospectively collected data in a university based surgical oncology practice. Records of all patients undergoing sentinel lymph node biopsy for breast cancer between August, 2007 and April, 2008 were reviewed (the switch from Isosulfan to Methylene blue was made in August of 2007). Local complication of fat necrosis was recorded. Tumor stage, neoadjuvant therapy, volume and dilution of dye used were analysed for association with fat necrosis.
 Results: One hundred and three patients underwent sentinel node biopsy for breast cancer during the study period. Seven (7%) patients developed fat necrosis at the site of injection. The rate of injection site fat necrosis is associated with the volume of methylene blue [0% for <3cc and 7.2% for > 3cc (p = 0.0071)]; there was no association with tumor stage [3.2% for stage <1, 13.1% for stage 2 and 0% for stage 3 (p=0.343)] and tumor type [7.3% for invasive ductal cancer, 8.3% for invasive lobular and 0% for in situ cancer (p=1.000)].
 Discussion: While methylene blue has typically been viewed as an inert agent for sentinel node biopsy, our study documents a 7% rate of fat necrosis. This is clinically significant in terms of painful symptoms and also the work-up that it may necessitate as a new mass in a breast cancer patient which has suspicious appearance on traditional imaging studies. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4140.
Published Version
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