Abstract
Objective:To determine the diagnostic accuracy of methylene blue dye to detect axillary lymph node metastases in patients with breast carcinoma by taking histopathology as gold standard.Methods:This quasi experimental study was done at Department of Surgery of Dow University Hospital Karachi during January 2013 to September 2015 after the approval of Hospital Ethical Committee. A total number of 85 patients with biopsy proven carcinoma were included in the study.1% methylene blue dye was infiltrated in the peri tumoural area of the diseased breast. The blue stained node called sentinel lymph node (SLN) was recognized and carefully dissected out. SLN and mastectomy with axillary clearance specimen was sent for histopathology in two separate bottles and the report of the histopathology was compared.Results:The axillary lymph nodes were positive for carcinoma in 61 cases out of 85(71.7%). Two of the patients had negative sentinel lymph node but positive non sentinel lymph node (false negative), and in three cases sentinel lymph node were involved only but not the rest of the axilla (False positive). The sensitivity, specificity and accuracy were 96.8%,86.36% and 94.1% respectively.Conclusion:Methylene blue dye technique is a reliable and safe diagnostic modality for detection of Sentinel lymph node in breast cancer patient because of its high accuracy.
Highlights
Breast carcinoma is the most common cancer of women worldwide including 23% of all female cancers.[1]
The axillary lymph node status is a significant measurement to plan the consequent adjuvant treatment of breast carcinoma and is the most important prognostic factor. It is assessed by sentinel lymph node (SLN) biopsy which is defined as the lymph node that receives lymphatic drainage from tumor earliest[4] this node has the highest chances to contain metastatic breast cancer
Combined use of radioactive colloid and blue dye injection is considered as gold standard for axillary sentinel lymph node biopsy (SLNB) in breast cancer with 97% accuracy rate,[8,9,10] but this combine usage does not attain an adequately higher detection rate to defend the cost.[11]
Summary
Breast carcinoma is the most common cancer of women worldwide including 23% of all female cancers.[1]. Correspondence: December 11, 2015 February 4, 2016 February 10, 2016 of Breast cancer.[3] The axillary lymph node status is a significant measurement to plan the consequent adjuvant treatment of breast carcinoma and is the most important prognostic factor. It is assessed by sentinel lymph node (SLN) biopsy which is defined as the lymph node that receives lymphatic drainage from tumor earliest[4] this node has the highest chances to contain metastatic breast cancer. The efficiency of detecting SLN by Methylene blue is as good as Isosulfan blue with cost effectiveness and is equal to ALND in breast cancer, but there is difference between the percentages of positive results in different studies.[15]
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