Abstract
<i>Background:</i> Axillary staging is the standard of care for all breast cancers amenable to curative treatment. Sentinel lymph node biopsy (SLNB) has been established as the gold standard for axillary staging and has supplanted axillary lymph node dissection (ALND) as a means of regional nodal staging in clinically node-negative breast cancer. Different blue dyes like isosulfan blue dye, patent blue, sulfan blue, radio labeled substances, and methylene blue dye (MBD) have been evaluated for the sentinel node procedure. <i>Aim of the study:</i> The aim of this study was to assess the efficacy of sentinel lymph node biopsy with methylene blue dye in clinically axillary node negative early-stage breast carcinoma as well as to observe the early postoperative outcome of SLN procedure. <i>Method:</i> Between November 2015 to October2017, a total of 18 female patients of 18 years and above, with diagnosis of early-stage (T1/T2) breast carcinoma with clinically negative ipsilateral axillary lymph nodes were studied in the department of surgical oncology, NICRH. Written informed consents were obtained from all patients. <i>Results:</i> In this study, the highest population was in 31-50 years age group with a mean age of 46(SD 12). Out of 18 cases, SLN(s) was identified in 15 cases by using MBD. The identification rate was 83.3%. In frozen section biopsy all SLNs were found positive for malignant cells. Two or more SLNs were positive in 12(66.6%) cases where SLNB was extended to ALND. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 100, 50, 80 and 100, respectively. Postoperative morbidity was significantly high in ALND group. <i>Conclusion:</i> This study showed that SLNB is a safe procedure and efficacy of this procedure was very significant. It lowers the unnecessary extended surgery (ALND) which has troublesome postoperative complications. Multicenter studies are required to extract more relevant information in this regard.
Highlights
Breast cancer is a major health problem and was among the top three most common malignancies globally in 2012 as well as it is the most common cancer in women, with an estimated 1.67 million new cases diagnosed in 2012. [1] The AJCC staging system evaluates tumor size and extent of tumor invasion, the presence and location of lymph node metastasis, and distant organ metastasis, and correlates these characteristics with survival data to produce a prognostic staging category for the patient. [2] In addition, data by prognostic stage on the efficacy of surgery, radiation, hormonal and chemotherapy to improve survival
[9] Over the last few decades, clinical trials comparing the effectiveness of Sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) have randomized over 9000 patients with early breast cancer. [1014] They have demonstrated that SLNB reduces the risk of arm morbidity and lymphoedema, and shortens the postoperative hospital stay without significantly increasing locoregional recurrence or survival, with two trials reporting data at mean follow-up times of approximately 8 years. [14, 15] One main pitfall is the failure to visualize the SLN, resulting in incorrect tumor staging, leading to suboptimal treatment or axillary recurrence
Frozen section results show almost 83.3% cases were positive in frozen section and rests were negative. 66.7% cases were undergoing for ALND where as other 33.3% were SNB
Summary
Breast cancer is a major health problem and was among the top three most common malignancies globally in 2012 as well as it is the most common cancer in women, with an estimated 1.67 million new cases diagnosed in 2012. [1] The AJCC staging system evaluates tumor size and extent of tumor invasion, the presence and location of lymph node metastasis, and distant organ metastasis, and correlates these characteristics with survival data to produce a prognostic staging category for the patient. [2] In addition, data by prognostic stage on the efficacy of surgery, radiation, hormonal and chemotherapy to improve survival. There is no documentation or study found in Bangladesh in favor of sentinel lymph biopsy in clinically node negative early-stage breast cancer. Our aim of this study to assess the efficacy of sentinel node biopsy with MBD in clinically node negative early-stage breast cancer as well as the early postoperative outcome of Khandakar A. Aim of the study: The aim of this study was to assess the efficacy of sentinel lymph node biopsy with methylene blue dye in clinically axillary node negative early-stage breast carcinoma as well as to observe the early postoperative outcome of SLN procedure. Method: Between November 2015 to October 2017, a total of 18 female patients of 18 years and above, with diagnosis of early-stage (T1/T2) breast carcinoma with clinically negative ipsilateral axillary lymph nodes were studied in the department of surgical oncology, NICRH. Multicenter studies are required to extract more relevant information in this regard
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