Subareolar blue dye only injection sentinel lymph node biopsy could reduce the numbers of standard axillary lymph node dissection in environments without access to nuclear medicine

Abstract

The gold standard of axillary sentinel lymph node biopsy (SLNB) in breast cancer is the combination of radioactive colloid and blue dye injection. Worldwide, numerous hospitals without access to radioactive tracers still perform a routine complete axillary lymph node dissection (ALND). We retrospectively analyzed the false negative rate and identification rate of SLNB with injection of blue dye in the absence of radioactive colloid and compared the subareolar (SA) and the peritumoral (PT) injection. Two hundred and fourteen patients with clinically node negative unifocal breast cancer of up to 3 cm in size who underwent SLNB followed by ALND were included. Patent Blue V was injected at the SA site in 120 patients or at the PT site in 94 patients. Thirty-seven (31%) patients in the SA group and 28 (29.8%) in the PT group were node-positive by ALND. The mean number of SLNs identified was 3.1 in the SA group and 1.6 in the PT group. The SLN identification rate was 91.7% for the SA group and 80.9% for the PT group (P = 0.017). The false negative rate was 3.6% in the SA group and 11.8% in the PT group (P = 0.032). Our study shows an acceptable low false negative rate for the SA blue dye only injection and confirms the higher identification rate of SA versus PT localisation. This technique could have spared 67.5% (81 out of 120) of our patients the ALND and could replace ALND of early breast cancer patients in environments without access to nuclear medicine.