J Breast Cancer.  2010 Mar;13(1):59-64. 10.4048/jbc.2010.13.1.59.

Endoscopic Sentinel Lymph Node Biopsy in Breast Cancer Surgery: Feasibility and Accuracy of the Combined Radioisotope and Blue Dye

• Woo HD
• Han SW
• Son DM
• Kim SY
• Lim CW
• Lee MH

• KMID: 2286561
• DOI: http://doi.org/10.4048/jbc.2010.13.1.59

Abstract

PURPOSE
Since its introduction in the mid-1990s, sentinel lymph node biopsy has been rapidly and widely adopted for the axillary staging of clinically node-negative breast cancer patients. However, there is some controversy in the clinical application because of its various identification rates and its false negative rates. The objective of this study was to assess the usefulness of endoscopic sentinel lymph node biopsy (ESNB) and to compare the value of two methods for identification of ESNB using blue dye only or a combination of blue dye and radioisotope.
METHODS
This study was carried out in 137 breast cancer patients (bilateral breast cancer, 3 cases) who underwent ESBN, at the Department of Surgery in Soonchunhyang University from May of 2007 to August of 2008. The technique involved the injection of 5 mL of 0.5% indigocarmine or Tc-99m tin colloid into subareolar plexus. The Visiport docked with a telescope was inserted through a low transverse axillary incison (1.0 cm in size) lateral to the pectoralis major. During the dissection, we identified sentinel nodes by following blue-stained lymphatic duct directly into blue-stained lymph nodes. We compared the value of two methods for identification of ESNB using blue dye only or a combination of blue dye and radioactive tracer.
RESULTS
The mean number of sentinel nodes was 1.27 (range, 1-4). The identification rate and false negative rate of the sentinel node were 94.3% (132/140) and 6.9% (3/43), respectively. We compared ESNB with using blue dye only (n=77) vs. a combination of blue dye and radioactive tracer (n=63). Sentinel lymph node identification rate were 90.9% (70/77) vs. 98.4% (62/63) (p=0.043).
CONCLUSION
The endoscopic technique of sentinel node biopsy can keep better operative visual fields and is less invasive. The combination of blue dye and radioactive tracer was superior to blue dye only for identification rates.

Keyword

Biological dye; Radioisotopes; Sentinel lymph node; Surgical endoscopy biopsy

MeSH Terms

Biopsy
Breast
Breast Neoplasms
Colloids
Humans
Lymph Nodes
Nitriles
Pyrethrins
Radioisotopes
Sentinel Lymph Node Biopsy
Telescopes
Tin
Visual Fields
Colloids
Nitriles
Pyrethrins
Radioisotopes
Tin

Figure

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  Figure 1 Endoscopic view of sentinel lymph node and draining lymph duct through Visiport. The arrow points to a dye-stained sentinel lymph node (SLN) and draining lymph duct (LD).

• 

  Figure 2 Stained lymph node during sentinel lymph node biopsy.

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