Sentinel Lymph Node Biopsy in Breast Cancer Using Methylene Blue Dye: Experience at Sir Ganga Ram Hospital Lahore

Abstract

Andleeb Khanam, Hurriat Afzal, Huma Aslam and Mohammad Abbas

Background: sentinel lymph node biopsy is used widely for the management of breast cancer. Axillary lymph node involvement is a very good prognostic indicator in breast cancer. It is the first node draining the primary tumor and is the first node to be involved by the cancer.

Objectives: The purpose of this study was to find out the accuracy, sensitivity and specificity of sentinel lymph node biopsy by using methylene blue dye in our setting.

Methods: It is a case series study. The study was conducted in the surgical unit 3 Sir Ganga Ram Hospital Lahore from February 2017 to July 2018. Patients with breast lump diagnosed as breast carcinoma on needle biopsy and clinically impalpable lymph nodes in axilla were subjected to sentinel lymph node biopsy using methylene blue dye. 42 patients were selected by purposive simple random technique planned for modified radical mastectomy. Sentinel lymph node biopsy was performed by injecting blue dye in sub areolar region. Mastectomy performed then axilla dissected out to find out blue stained sentinel lymph node. Stained node/nodes were taken out and placed in separate jar. Level II axillary clearance now done to complete the procedure. Both specimens were sent for histopathology. All patients are followed up till now.

Results: out of 42 patients true positive results were in 39 cases i.e metastasis detected in 16 cases in sentinel node and so in the axillary nodes, in 33 patients no metastasis found in sentinel as well as in axillary nodes, only in 3 cases false negative results seen there were no false positive cases. Sensitivity was 92% and specificity 99%.

Conclusion: Sentinel lymph node biopsy using Methylene blue dye is a safe and feasible procedure to identify the sentinel lymph node in patients of breast cancer with impalpable axillary nodes. In our study this technique is proved to be effective in staining the sentinel lymph node by which unnecessary axillary dissection can be avoided in breast cancer surgery.

PDF