A study on accuracy of sentinel lymph Node biopsy using methylene blue in clinically No. breast carcinoma

Authors

  • Joel John Senior Resident, Department of Surgery, Government Medical College, Kottayam, India
  • Sansho EU Associate Professor (CAP), Department of Surgery, Government Medical College, Kottayam, India
  • Sheeja S (CAP) Professor, Department of Pathology, Government Medical College, Kottayam, India
  • John S Kurien Professor and HOD, Department of Surgery, Government Medical College, Kottayam, India

Keywords:

Methylene blue, sentinel lymphnode biopsy

Abstract

Background: Lymphatic mapping of breast has the potential of changing the standard of surgical care in carcinoma breast patients. The continued interest in less extensive surgery , the need for faster recovery and the increasing demand for early discharge have brought the value of axillary lymph node dissection (ALND) into close scrutiny and led to the emergence of less invasive procedures like sentinel lymph node biopsy as an accepted means of staging the axillary lymph nodes. Our study aims at bringing this method more accessible at affordable cost at suburban areas by using methylene blue dye in place of costlier dyes. Methods: We injected 3ml of methylene blue subareolarly in three places depending on the quadrant in which tumour is situated, before putting incision for Modified Radical Mastectomy and thorough massaging was done for 5-7 minutes in clockwise manner. After the procedure the pathologist segregated the stained lymph nodes and studied and reported them separately along with all the dissected axillary lymph nodes. Once the histopathology report was obtained, we studied the incidence of positive lymph nodes in stained nodes and also incidence of positive nodes in unstained nodes. Then we calculated sensitivity, specificity, false negativity, positive predictive value, negative predictive value and accuracy of sentinel lymph node biopsy with methylene blue staining. Results: Of the 40 patients, Sentinel Lymph node was identified in 34 patients (85%). Among the 6 unidentified patients 5 were T1 disease. i.e. <2cm and had lump in the inner quadrants. Average time for detection of sentinel lymph identification after injecting dye was 41.5 minutes (20-75 min). False Negative rate, defined as proportion actually positive among those test negative was 4.34% in this study. In 1 of the 23 patients the sentinel node was negative for metastasis but axilla was positive. Total number of cases with positive axillary nodes was 22, i.e. both SLN and rest of the axilla also being positive for metastases, and SLN was negative for metastases in 1 cases (false negative rate of 4.34%). Total number of cases with negative axillary nodes was 17 i.e. with no evidence of metastasis of which 5 were unstained. With above mentioned results, the overall Sensitivity, Specificity, Positive Predictive Valve (PPV) And Negative Predictive Valve (NPV) of SLNB in predicting axillary node status was 95.65%, 29.41%, 64.71% and 83.34% respectively. The overall accuracy was 67.50% .None of the 40 patients in this study had any kind of adverse reactions like anaphylaxis or eczema due to the Methylene blue dye. Conclusion: SLNB with methylene blue is effective in Indian set of patient population especially in resource scarce regions, thus reducing the cost of the procedure and avoiding all the morbidity associated with unnecessary axillary lymphadenectomy, that too at a lower cost.

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Published

2021-08-30

How to Cite

Joel John, Sansho EU, Sheeja S, & John S Kurien. (2021). A study on accuracy of sentinel lymph Node biopsy using methylene blue in clinically No. breast carcinoma. International Journal of Health and Clinical Research, 4(15), 48–52. Retrieved from https://ijhcr.com/index.php/ijhcr/article/view/2392