Abstract
BackgroundThe combination of blue dye and radioisotope is most widely used to identify sentinel lymph nodes (SLNs) in patients with breast cancer. However, some individual studies suggested that dual tracers did not have an advantage over radioisotope alone in detecting SLNs. We performed a systematic review to investigate the added value of blue dye in addition to radioisotope.MethodsWe searched Pubmed and Embase. Prospective studies that compared the combination of radioisotope and blue dye with radioisotope alone were selected. The identification rate of SLNs and the false-negative rate were the main outcomes of interest. The odds ratios (ORs) and 95 % confidential intervals (CIs) were calculated by using random-effects model.ResultsTwenty-four studies were included. The combination of radioisotope and blue dye showed higher identification rate than radioisotope alone (OR = 2.03, 95 % CI 1.53–2.69, P < 0.05). However, no statistically significant difference was revealed for patients after neoadjuvant chemotherapy (OR = 1.64, 95 % CI 0.82–3.27, P > 0.05), or for studies with high proportion of patients with positive lymphoscintigraphy (OR = 1.41, 95 % CI 0.83–2.39, P > 0.05). Dual tracers did not significantly lower the false-negative rate compared with radioisotope alone (OR = 0.76, 95 % CI 0.44–1.29, P > 0.05).ConclusionsAlthough the combination of blue dye and radioisotope outperformed radioisotope alone in SLN detection, the superiority for dual tracers may be limited for patients with positive lymphoscintigraphy or for those after neoadjuvant chemotherapy. Besides, the combined modality did not help lower the false-negative rate.
Highlights
The combination of blue dye and radioisotope is most widely used to identify sentinel lymph nodes (SLNs) in patients with breast cancer
2 % of patients undergoing sentinel lymph node biopsy (SLNB) would experience allergic reactions to blue dye [9], with the most severe case presenting as hypotension [10]
The results from a large case series suggested that the marginal benefit for blue dye declined with increased surgical experience in radioisotope-mapping technique [12]
Summary
The combination of blue dye and radioisotope is most widely used to identify sentinel lymph nodes (SLNs) in patients with breast cancer. Since the early 1990s, blue dye and radioisotope have emerged as the most commonly used tracing agents to locate SLNs in breast. 2 % of patients undergoing SLNB would experience allergic reactions to blue dye [9], with the most severe case presenting as hypotension [10]. Several authors argued that the added value of blue dye over radiotracer alone technique was only minimal or marginal [9,10,11]. The results from a large case series suggested that the marginal benefit for blue dye declined with increased surgical experience in radioisotope-mapping technique [12]
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