P3-07-38: Selective Omission of Blue Dye in Patients Undergoing Sentinel Lymph Node Biopsy for Breast Cancer.
Authors: Waters JL , Iqbal M , Jones L , Harries S , Clarke D 
Published: June 2012

Background

Combined blue dye and radioisotope colloid injection with scintigraphy is standard practice for mapping and biopsy of sentinel lymph node in breast cancer within the UK. Whilst this combination aids sentinel node detection rate, blue dye has a number of possible adverse effects including anaphylaxis (reported as 1–3% of patients), semi-permanent skin tattooing and staining of bodily fluids which may cause distress for the unwary patient. It can also cause obscuration of the operating field, making identification and dissection of planes more difficult.

Methods: Patients undergoing sentinel lymph node biopsy (SLNB) using either a combination of blue dye and radioactive colloid, or radioactive colloid alone during a 14 month period were compared for identification rate, node harvest number and final positive rate. A total of 122 axillary sentinel node biopsies in 121 patients were identified. All patients scheduled for sentinel lymph node biopsy had intradermal injection of radiocolloid and lymphoscintigram preoperatively and were checked for radioactive intensity with gamma probe on the table before draping for surgery. Patients with good signal proceeded to surgery without blue dye. Those with more than 3 nodes (n=9), radioisotope skin contamination (n=2), absent signal on scintigraphy (n=7) and/or with weak pre-operative radioactive signal (n=22) were given 2 millilitres of patent V dye subdermally in the periareolar region. Sentinel node biopsy then proceeded in the standard fashion. Data was also collected from the year prior to be used as a control group, where the combination of blue dye and radioisotope was used for all patients (n=90), and compared with the group receiving radioisotope alone.

Results: The rate of identification for single agent and dual agent was 100% and 97.5% respectively, with no significant difference in mean node harvest using radioisotope alone (1.80) as compared to combined technique (1.87 p= 0.88, 95%CI −0.39 to 0.34). There was no significant difference in the number of patients with positive nodes on final histology when using single agent (13 (14%)) when compared to the dual agent technique (10 (25%) p=0.21). There was also no difference in the rate or number of node harvest in the group who underwent the single agent technique when compared to the control group (100% identification, mean harvest 1.84, p=0.77, 95% CI −0.36 to 0.27), with no difference in node positivity (16 (17%) p=0.68). No intra operative adverse reaction was reported in any of the groups.

Discussion: This study has shown no significant difference in the localisation rate when selectively omitting blue dye in suitable patients compared to the combined technique. This may be due to significant operator experience or change in the method of radioisotope injection since initial studies were performed. In this study, 86 out of 126 SLNB proceeded without blue dye, meaning not only a reduction in the number of patients with minor adverse effects, but also a potential reduction in severe adverse reaction of 68% or 2 patients per year within this breast unit.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-38.