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. 2021 Jan 11;134(3):318-325.
doi: 10.1097/CM9.0000000000001359.

Retrospective analysis of sentinel lymph node biopsy using methylene blue dye for early breast cancer

Shan Yang  1 , Hong-Yu Xiang  1 , Ling Xin  1 , Hong Zhang  2 , Shuang Zhang  2 , Yuan-Jia Cheng  1 , Qian Liu  1 , Ling Xu  1 , Ting Li  2 , Xue-Ning Duan  1 , Jing-Ming Ye  1 , Yin-Hua Liu  1
Affiliations

Retrospective analysis of sentinel lymph node biopsy using methylene blue dye for early breast cancer

Shan Yang et al. Chin Med J (Engl). .

Abstract

Background: Methylene blue is the most commonly used tracer for sentinel lymph node (SLN) biopsy (SLNB) in China. This study aimed to investigate the feasibility of clinical application of SLNB using methylene blue dye (MBD) for early breast cancer and the prognosis of patients with different SLN and non-SLN statuses.

Methods: We retrospectively analyzed the clinicopathological data of patients with early breast cancer treated at the Peking University First Hospital between 2013 and 2018. We calculated the SLN identification rate (IR) in SLNB with MBD and the false-negative rate (FNR), and analyzed the prognosis of patients with different SLN and non-SLN statuses using Kaplan-Meier curves.

Results: Between January 2013 and December 2018, 1603 patients with early breast cancer underwent SLNB with MBD. The SLN IR was 95.8% (1536/1603). Two SLNs (median) were detected per patient. There were significant differences in FNR between patients with SLN micrometastasis and macrometastasis (19.0% vs. 4.5%, χ2 = 12.771, P < 0.001). Chi-square test showed that there were significant differences in SLN successful detection rates among patients with different vascular tumor embolism status (96.3% vs. 90.8%, χ2 = 9.013, P = 0.003) and tumor (T) stages (96.6% vs. 94.1%, χ2 = 5.189, P = 0.023). Multivariate analysis showed that vascular tumor embolism was the only independent factor for SLN successful detection (odds ratio: 0.440, 95% confidence interval: 0.224-0.862, P = 0.017). Survival analysis showed a significant difference in disease-free survival (DFS) between patients with non-SLN metastasis and patients without non-SLN metastasis (P = 0.006).

Conclusion: Our single-center data show that, as a commonly used tracer in SLNB in China, MBD has an acceptable SLN IR and a low FNR in frozen sections. This finding is consistent with reports of dual tracer-guided SLNB. Positive SLNs with non-SLN metastasis are associated with DFS.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Flow chart of the inclusion of the patients. ITC: Isolated tumor cells; SLN: Sentinel lymph node; SLNB: Sentinel lymph node biopsy.
Figure 2
Figure 2
Kaplan-Meier analyses of disease-free survival (A) and overall survival (B) in 1429 patients. SLNB: Sentinel lymph node biopsy.
Figure 3
Figure 3
Kaplan-Meier analyses of disease-free survival (A) and overall survival (B) in the non-SLN, non-metastasis group, and non-SLN metastasis group. SLN: Sentinel lymph node.
See this image and copyright information in PMC

References

    1. Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Ashikaga T, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol 2007; 8:881–888. doi: 10.1016/S1470-2045(07)70278-4. - PubMed
    1. Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol 2010; 11:927–933. doi: 10.1016/S1470-2045(10)70207-2. - PMC - PubMed
    1. Gradishar WJ, Anderson BO, Abraham J, Aft R, Agnese D, Allison KH, et al. Breast cancer, version 3.2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2020; 18:452–478. doi: 10.6004/jnccn.2020.0016. - PubMed
    1. Zhang J, Wang T, Yan C, Huang M, Fan Z, Ling R. Clinical practice status of sentinel lymph node biopsy for early-stage breast cancer patients in china: a multicenter study. Clin Epidemiol 2020; 12:917–924. doi: 10.2147/CLEP.S264349. - PMC - PubMed
    1. Chinese Society of Breast Surgeons of Chinese Medical Association Expert consensus and technical operation guidelines for dye-guided sentinel lymph node biopsy for early breast cancer. Chin J Pract Surg 2018; 38:855–858. doi: 10.19538/j.cjps.issn1005-2208.2018.08.04.