J Breast Cancer.  2006 Mar;9(1):18-24. 10.4048/jbc.2006.9.1.18.

The Clinical Utility of Indigo Carmine in Sentinel Lymph Node Biopsy of the Breast Cancer

Affiliations
  • 1Department of Surgery, Korea University College of Medicine, Seoul, Korea. kujwbae@unitel.co.kr

Abstract

BACKGROUND
The selection of blue dye or technetium radioisotope depends on the surgeon? experience or the availability of the center in sentinel lymph node biopsy (SLNB). The purpose of this study is to evaluate the possibility of clinical usage of indigo carmine in SLNB in breast cancer.
METHODS
From the July 2001 to the March 2004, 93 consecutive cases of Tis - T2 breast cancers without palpable axillary lymph nodes were enrolled to the SLNB. After usual preparation for the breast conserving surgery or mastectomy, the patients were intradermally injected with 5 ml of indigo carmine around the subareolar area. After 4 minutes has passed, usual axillary incision of breast conserving surgery was made, and the stained lymphatics were followed to the firstly encountered lymph nodes. The dissected nodes were sent to the department of pathology for frozen and permanent sections. After SLNB, axillary lymph node dissections (ALND) were completed regardless of the result of the frozen section.
RESULTS
The identification rate of SLNB using Indigo carmine was 97.8% (91/93). The axillary node metastases on complete ALND were 21 cases. 18 cases were detected with SLNB, and 3 cases were falsely reported as negative on SLNB. 11 cases had metastases in the sentinel nodes only (52.4%). Among the 3 false negative cases, one case had axillary metastasis solely in a node in level III (infraclavicular node). The sensitivity of the test was 85.7% (18/21), and the specificity was 100% (70/70). False negative rate was 9.5% (2/21), and negative predictive value was 95.9% (70/73).
CONCLUSIONS
Sentinel node biopsy using indigo carmine showed similar identification rate and false negative rate with other blue dye only methods including isosulfan blue. Because indigo carmine is more available and safe than isosulfan blue, it could be an alternative to isosulfan blue.

Keyword

Breast cancer; Sentinel lymph node biopsy; Indigo Carmine

MeSH Terms

Biopsy
Breast Neoplasms*
Breast*
Frozen Sections
Humans
Indigo Carmine*
Lymph Node Excision
Lymph Nodes
Mastectomy
Mastectomy, Segmental
Neoplasm Metastasis
Pathology
Sensitivity and Specificity
Sentinel Lymph Node Biopsy*
Technetium
Indigo Carmine
Technetium

Reference

1. Hansen NM, Grube BJ, Giuliano AE. The time has come to change the algorithm for the surgical management of early breast cancer. Arch Surg. 2002. 137:1131–1135.
Article
2. Leong SP, Morita ET, Treseler PA, Wong JH. Multidisciplinary approach to selective sentinel lymph node mapping in breast cancer. Breast Cancer. 2000. 7:105–113.
Article
3. Staradub VL. Harris JR, Lippman ME, Morrow M, Osborne CK, editors. Technique in surgery, sentinel node biopsy and axillary dissection. Diseases of the breast. 2004. 3rd ed. Philadelphia: Lippincott Williams & Wilkins.
4. Raut CP, Daley MD, Hunt KK, Akins J, Ross MI, Singletary SE, et al. Anaphylactoid reactions to isosulfan blue dye during breast cancer lymphatic mapping in patients given preoperative prophylaxis. J Clin Oncol. 2004. 22:567–568.
Article
5. Sprung J, Tully MJ, Ziser A. Anaphylactic reactions to isosulfan blue dye during sentinel node lymphadenectomy for breast cancer. Anesth Analg. 2003. 96:1051–1053.
Article
6. Quiney NF, Kissin MW, Tytler I. Anaphylactic reaction to isosulphan blue. Br J Anaesth. 2003. 90:105–106.
Article
7. Stefanutto TB, Shapiro WA, Wright PM. Anaphylactic reaction to isosulphan blue. Br J Anaesth. 2002. 89:527–528.
Article
8. Sadiq TS, Burns WW 3rd, Taber DJ, Damitz L, Ollila DW. Blue urticaria: a previously unreported adverse event associated with isosulfan blue. Arch Surg. 2001. 136:1433–1435.
9. Albo D, Wayne JD, Hunt KK, Rahlfs TF, Singletary SE, Ames FC, et al. Anaphylactic reactions to isosulfan blue dye during sentinel lymph node biopsy for breast cancer. Am J Surg. 2001. 182:393–398.
Article
10. Kuerer HM, Hunt KK, Singletary SE, Ames FC. Unusual aspects of breast cancer: case 3. Blue hives during lymphatic mapping for breast cancer. J Clin Oncol. 2001. 19:2573–2574.
11. Lyew MA, Gamblin TC, Ayoub M. Systemic anaphylaxis associated with intramammary isosulfan blue injection used for sentinel node detection under general anesthesia. Anesthesiology. 2000. 93:1145–1146.
Article
12. Longnecker SM, Guzzardo MM, Van Voris LP. Life-threatening anaphylaxis following subcutaneous administration of isosulfan blue 1%. Clin Pharm. 1985. 4:219–221.
13. Kern KA. Sentinel lymph node mapping in breast cancer using subareolar injection of blue dye. J Am Coll Surg. 1999. 189:539–545.
Article
14. Aihara T, Takatsuka Y. Dye-guided sentinel node biopsy revisited; validation and observational study from a single institute. Breast Cancer. 2003. 10:254–259.
Article
15. Lee EK, Park YL, Pae WK. Endoscopic sentinel node biopsy. J Korea Breast Cancer Soc. 2003. 6:174–179.
Article
16. Tsopelas C, Sutton R. Why certain dyes are useful for localizing the sentinel lymph node. J Nucl Med. 2002. 43:1377–1382.
17. Noguchi M, Motomura K, Imoto S, Miyauchi M, Sato K, Iwata H, et al. A multicenter validation study of sentinel lymph node biopsy by the Japanese Breast Cancer Society. Breast Cancer Res Treat. 2000. 63:31–40.
Article
18. Yang JH, Lee SD, Park HL, Nam SJ, Ko YH, Ree HJ, et al. Clinical application of sentinel node biopsy in T1 or less breast cancers: is it effective or feasible? J Korea Breast Cancer Soc. 1992. 2:146–151.
Article
19. Choi JW, Lee HD, Park BW, Jung WH, Oh KK, Ryu YH. Experiences with sentinel lymphadenectomy in 157 cases of breast carcinoma. J Korea Breast Cancer Soc. 2002. 5:38–45.
Article
20. Park JM, Jin SH, Kim MW, Yim HE, Park CH, Chung KI, et al. Sentinel lymph node biopsy using technetium- 99m antimony sulfide colloid and isosulfan blue dye in breast cancer patients. J Korea Breast Cancer Soc. 2002. 5:168–174.
Article
21. Kim SW, Park IA, Chung JK, Yeo JS, Moon WK, Cha JH, et al. Prospective study of 162 sentinel lymph node biopsies in breast cancer: usefulness of ultrasonography in patients selection. J Korea Breast Cancer Soc. 2003. 6:103–108.
Article
22. Kang SH, Lee ES, Kang HS, Ro JS, Lee S, Kang KW. Neoadjuvant chemotherapy decreases the identification rate of sentinel lymph node biopsy. J Korea Breast Cancer Soc. 2003. 6:95–102.
Article
23. Schwartz GF. Clinical practice guidelines for the use of axillary sentinel lymph node biopsy in carcinoma of the breast: current update. Breast J. 2004. 10:85–88.
Article
24. O'Hea BJ, Hill AD, El-Shirbiny AM, Yeh SD, Rosen PP, Coit DG, et al. Sentinel lymph node biopsy in breast cancer: initial experience at Memorial Sloan-Kettering Cancer Center. J Am Coll Surg. 1998. 186:423–427.
25. Imoto S, Hasebe T. Initial experience with sentinel node biopsy in breast cancer at the National Cancer Center Hospital East. Jpn J Clin Oncol. 1999. 29:11–15.
Article
26. Chagpar A, Martin RC 3rd, Chao C, Wong SL, Edwards MJ, Tuttle T, et al. Validation of subareolar and periareolar injection techniques for breast sentinel lymph node biopsy. Arch Surg. 2004. 139:614–618. discussion 618-20.
Article
Full Text Links
  • JBC
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr