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Accarain AA, Laureys M, Joyeux L, Damry N, Steyaert H, Reusens H. Arterial Embolization and Methylene Blue Injection into the Aberrant Artery in Two Infants with Intralobar Sequestration. European J Pediatr Surg Rep 2022; 10:e141-e144. [PMID: 36225531 PMCID: PMC9550518 DOI: 10.1055/s-0042-1757570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 03/02/2022] [Indexed: 11/25/2022] Open
Abstract
Bronchopulmonary sequestration is a rare congenital lung dysplasia. An intralobar sequestration (ILS) is a nonfunctional mass within the lung parenchyma without bronchial communication and with aberrant systemic arterial blood supply. Surgical resection or close observation can be proposed in the management of asymptomatic and low-risk ILS, but there is a lack of consensus. Endovascular embolization before thoracoscopic resection of ILS has been described to limit perioperative bleeding. Another technique previously reported is the injection of methylene blue in the feeding artery to macroscopically mark the sequestration from the healthy lung. In that way, a nonanatomical resection can be performed instead of a lobectomy without the risk of leaving abnormal lung tissue in place. We describe the first two cases of these two techniques combined: a 3-year-old girl with an ILS in the right lower lobe with an artery originating from the abdominal aorta, and a 14-month-old girl with an ILS in the right lower lobe with an artery coming from the celiac trunk. The combination of embolization and injection of methylene blue in the aberrant artery leads to a clear macroscopic demarcation of the blue-colored ILS from the healthy lung parenchyma and allowed safe nonanatomical resection of the ILS without risk of bleeding or compromising normal lung tissue.
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Affiliation(s)
- Anna Ayako Accarain
- Department of Surgery, Université Libre de Bruxelles, Brussels, Belgium,Address for correspondence Dr. Anna Ayako Accarain Department of Surgery, Université Libre de BruxellesRte de Lennik 808, Brussels 1010Belgium
| | - Marc Laureys
- Department of Radiology, Brugmann University Hospital, Brussels, Belgium
| | - Luc Joyeux
- Department of Pediatric Surgery, Hopital Universitaire des Enfants Reine Fabiola, Bruxelles, Belgium
| | - Nasroola Damry
- Department of Radiology, Brugmann University Hospital, Brussels, Belgium
| | - Henri Steyaert
- Department of Pediatric Surgery, Hopital Universitaire des Enfants Reine Fabiola, Bruxelles, Belgium
| | - Helena Reusens
- Department of Pediatric Surgery, Hopital Universitaire des Enfants Reine Fabiola, Bruxelles, Belgium
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2
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Methods for sentinel lymph node mapping in oral cancer: a literature review. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Oral cancers, excluding non-melanoma skin cancer, are the most common cancers of the head and neck. Of these, 90% are squamous cell carcinomas (SCC). Surgery, which consists of dissection of the primary tumor and lymphadenectomy, is considered a radical method of treatment. There are several ranges of cervical lymphadenectomy: selective neck dissection (SND), modified radical neck dissection (MRND), and radical neck dissection (RND). The extension of surgery depends on the stage of clinical advancement, which can be determined by TNM classification, among other methods. The greatest controversy is related to SND in patients with cN0 (no evidence of regional lymph node metastasis), which is currently standard procedure. This approach is dictated by the possibility of hidden or subclinical metastases. The use of the sentinel lymph node (SLN) concept in patients with early stage of oral cancer and appropriate methods of its mapping may lead to a reduction in the extent of the lymphadenectomy procedure, thus reducing postoperative mortality and maintaining the patient’s function and quality of life, with correct oncological results. So far, available methods for SLN mapping are based on use of markers: methylene blue dye (MBD), metastable radioactive isotope Technetium (99mTc), or the fluorescent substance indocyanine green (ICG).
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3
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Li L, Gao N, Yang AQ, Xu WH, Ding Y, Chu J, Lin XN, Liu JQ. Application of fluorescein combined with methylene blue in sentinel lymph node biopsy of breast cancer. Sci Rep 2021; 11:12119. [PMID: 34108563 PMCID: PMC8190180 DOI: 10.1038/s41598-021-91641-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/28/2021] [Indexed: 02/06/2023] Open
Abstract
Sentinel lymph node biopsy (SLNB) for axillary lymph node staging in early breast cancer has been widely recognized. The combination of radio-colloids and dye method is the best method recognized. The reagents and equipment required in the process of the combined method are complex and expensive, so there are certain restrictions in the use of primary medical institutions. As a new tracer, fluorescent tracer technology has attracted much attention. We aimed to evaluate the feasibility and safety of fluorescein for SLNB in breast cancer. In this study, a total of 123 patients with breast cancer were divided into group A (n = 67) and group B (n = 56). The efficacy of Indocyanine green (ICG) combined with methylene blue (group A) and fluorescein combined with methylene blue (group B) in SLNB of breast cancer was compared, complications were observed at the same time. No local or systemic reactions were observed in the two groups. In group A, Sentinel lymph nodes of breast cancer were detected in 63 patients, with a detection rate of 94.0% (63/67), a false-negative rate of 7.5% (4/53). In group B, Sentinel lymph nodes of breast cancer were detected in 52 patients, with a detection rate of 92.9% (52/56), a false-negative rate of 7.5% (3/40). There was no significant difference in biopsy results between the two groups. This prospective clinical study suggests that SLNB using fluorescein and ultraviolet LED light is feasible in breast cancer patients. No adverse reactions were observed in this study, but larger studies are needed to properly assess the adverse reaction rate.
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Affiliation(s)
- Liang Li
- Department of Breast Surgery, Zibo Central Hospital, Shandong First Medical University, Zibo, Shandong Province, China
| | - Ning Gao
- Department of Breast Surgery, Zibo Central Hospital, Shandong First Medical University, Zibo, Shandong Province, China.
| | - Ai Qing Yang
- Zibo Center for Disease Control and Prevention, Zibo, Shandong Province, China
| | - Wen Hao Xu
- Department of Breast Surgery, Zibo Central Hospital, Shandong First Medical University, Zibo, Shandong Province, China
| | - Yu Ding
- Department of Breast Surgery, Zibo Central Hospital, Shandong First Medical University, Zibo, Shandong Province, China
| | - Jun Chu
- Department of Breast Surgery, Zibo Central Hospital, Shandong First Medical University, Zibo, Shandong Province, China
| | - Xiao Na Lin
- Department of Breast Surgery, Zibo Central Hospital, Shandong First Medical University, Zibo, Shandong Province, China
| | - Jia Qi Liu
- Department of Breast Surgery, Zibo Central Hospital, Shandong First Medical University, Zibo, Shandong Province, China
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4
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Güler SA, Kırnaz S, Şimşek T, Demir Cİ, Güneş A, İşken T, Cantürk NZ, Utkan NZ. Cutaneous adverse effects of methylene blue in an animal skin-flap model. Acta Chir Belg 2020; 120:167-172. [PMID: 30724704 DOI: 10.1080/00015458.2019.1570742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background and objectives: Sentinel lymph node biopsy is important for metastasis surveillance in the management of a number of human cancers. Identification of sentinel lymph nodes may be facilitated by the use of several methods including methylene blue injection. However tissue necrosis is a known effect of methylene blue application. This study aimed to investigate the effects of methylene blue injection on skin flaps using a rodent model.Methods: Modified McFarlane flaps were prepared using Wistar Albino rats. Local injection of methylene blue was given to one group while saline was injected into the control group. A third group received systemic methylene blue via intraperitoneal injection. Observational and histological comparison was made between the groups to investigate the necrotic effects of methylene blue on skip flaps.Results: The control group's surviving flap areas were significantly larger than local methylene blue group's surviving flap area. However, there was no significant difference in skin flap survival area between the control group and the systemic methylene blue group. Furthermore, there is no significant difference between local and systemic methylene blue group's surviving flap areas.Conclusions: Local methylene blue injection increases skin necrosis and decreases rates of surviving flap areas in an experimental rat models.
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Affiliation(s)
- Sertaç Ata Güler
- General Surgery Department, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Sertaç Kırnaz
- General Surgery Department, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Turgay Şimşek
- General Surgery Department, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Can İlker Demir
- Plastic and Reconstructive Surgery Department, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Abdullah Güneş
- General Surgery Department, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Tonguç İşken
- Plastic and Reconstructive Surgery Department, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Nuh Zafer Cantürk
- General Surgery Department, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Nihat Zafer Utkan
- General Surgery Department, Kocaeli University School of Medicine, Kocaeli, Turkey
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5
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Zhang C, Jiang D, Huang B, Wang C, Zhao L, Xie X, Zhang Z, Wang K, Tian J, Luo Y. Methylene Blue-Based Near-Infrared Fluorescence Imaging for Breast Cancer Visualization in Resected Human Tissues. Technol Cancer Res Treat 2020; 18:1533033819894331. [PMID: 31835962 PMCID: PMC6913053 DOI: 10.1177/1533033819894331] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Breast-conserving surgery is facing the challenge of objective tumor margin identification intraoperatively. Near-infrared fluorescence imaging would be an ideal approach to visualize tumor margins during surgeries. In this preliminary study, the feasibility of methylene blue-based near-infrared fluorescence imaging technique for breast cancer detection was assessed in resected human breast specimens after breast cancer surgeries. Thirty patients with breast cancer scheduled for surgical treatment were enrolled, including 10 patients with preoperative chemotherapy and 20 patients without. Each of them received an injection of 1 mg/kg methylene blue intravenously 3 hours before the surgery. Then, a home-developed methylene blue-specific near-infrared fluorescence imaging system was employed to image the resected breast tissues and identify the tumor by the fluorescence contrast. Specimens were taken for pathological examinations as the reference. There were no severe adverse events attributable to methylene blue. Of 20 patients, who did not receive preoperative chemotherapy, 16 exhibited fluorescent contrast on their resected tissues (signal-to-background ratio: 1.94 ± 0.71). In contrast, tumors were identified in 3 of 10 specimens from patients who underwent preoperative chemotherapy (signal-to-background ratio: 1.63 ± 0.38). A total of 35 tissues were sampled from 30 specimens. Besides 30 tumor samples, 5 more suspicious samples with fluorescence signal were confirmed to be benign hemorrhagic tissues. Therefore, a sensitivity of 0.63 and a positive predictive value of 0.79 were achieved by the methylene blue fluorescence imaging strategy. Here, we demonstrate the feasibility of using methylene blue fluorescence imaging to identify breast cancer. Preoperative chemotherapy had an impact on imaging effect, which may reduce the detection rate. After all, methylene blue fluorescence imaging has great potential to be used into breast-conserving surgery for tumor-positive margins detection, but further clinical trial study is needed ( http://www.chictr.org.cn/ Clinical Trial Registry ID: ChiCTR1800015400, Near-infrared fluorescence imaging applied in breast cancer identification with methylene blue).
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Affiliation(s)
- Chong Zhang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.,Beijing Key Laboratory of Molecular Imaging, Beijing, China
| | - Daqing Jiang
- Department of Surgery, Cancer Hospital of China Medical University, Dadong District, Shenyang, Liaoning, China
| | - Bo Huang
- Department of Pathology, Cancer Hospital of China Medical University, Dadong District, Shenyang, Liaoning, China
| | - Cong Wang
- Department of Surgery, Cancer Hospital of China Medical University, Dadong District, Shenyang, Liaoning, China
| | - Lin Zhao
- Department of Surgery, Cancer Hospital of China Medical University, Dadong District, Shenyang, Liaoning, China
| | - Xianxin Xie
- Department of Surgery, Cancer Hospital of China Medical University, Dadong District, Shenyang, Liaoning, China
| | - Zhaohe Zhang
- Department of Radiology, Cancer Hospital of China Medical University, Dadong District, Shenyang, Liaoning, China
| | - Kun Wang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.,Beijing Key Laboratory of Molecular Imaging, Beijing, China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.,Beijing Key Laboratory of Molecular Imaging, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
| | - Yahong Luo
- Department of Radiology, Cancer Hospital of China Medical University, Dadong District, Shenyang, Liaoning, China
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Nedu ME, Tertis M, Cristea C, Georgescu AV. Comparative Study Regarding the Properties of Methylene Blue and Proflavine and Their Optimal Concentrations for In Vitro and In Vivo Applications. Diagnostics (Basel) 2020; 10:diagnostics10040223. [PMID: 32326607 PMCID: PMC7235860 DOI: 10.3390/diagnostics10040223] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/27/2020] [Accepted: 04/14/2020] [Indexed: 02/07/2023] Open
Abstract
Methylene blue and proflavine are fluorescent dyes used to stain nucleic acid from the molecular level to the tissue level. Already clinically used for sentinel node mapping, detection of neuroendocrine tumors, methemoglobinemia, septic shock, ifosfamide-induced encephalopathy, and photodynamic inactivation of RNA viruses, the antimicrobial, anti-inflammatory, and antioxidant effect of methylene blue has been demonstrated in different in vitro and in vivo studies. Proflavine was used as a disinfectant and bacteriostatic agent against many gram-positive bacteria, as well as a urinary antiseptic involved in highlighting cell nuclei. At the tissue level, the anti-inflammatory effects of methylene blue protect against pulmonary, renal, cardiac, pancreatic, ischemic-reperfusion lesions, and fevers. First used for their antiseptic and antiviral activity, respectively, methylene blue and proflavine turned out to be excellent dyes for diagnostic and treatment purposes. In vitro and in vivo studies demonstrated that both dyes are efficient as perfusion and tissue tracers and permitted to evaluate the minimal efficient concentration in different species, as well as their pharmacokinetics and toxicity. This review aims to identify the optimal concentrations of methylene blue and proflavine that can be used for in vivo experiments to highlight the vascularization of the skin in the case of a perforasome (both as a tissue tracer and in vascular mapping), as well as their effects on tissues. This review is intended to be a comparative and critical presentation of the possible applications of methylene blue (MB) and proflavine (PRO) in the surgical field, and the relevant biomedical findings from specialized literature to date are discussed as well.
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Affiliation(s)
- Maria-Eliza Nedu
- Department of Plastic Surgery, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 46-50 Viilor St., 400347 Cluj-Napoca, Romania; (M.-E.N.); (A.V.G.)
| | - Mihaela Tertis
- Department of Analytical Chemistry, Faculty of Pharmacy, Iuliu Hațieganu University of Medicine and Pharmacy, 4 Pasteur St., 400349 Cluj-Napoca, Romania;
| | - Cecilia Cristea
- Department of Analytical Chemistry, Faculty of Pharmacy, Iuliu Hațieganu University of Medicine and Pharmacy, 4 Pasteur St., 400349 Cluj-Napoca, Romania;
- Correspondence: ; Tel.: +40-264-597256
| | - Alexandru Valentin Georgescu
- Department of Plastic Surgery, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 46-50 Viilor St., 400347 Cluj-Napoca, Romania; (M.-E.N.); (A.V.G.)
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Faisal M, Sayed MG, Antonious K, Abo Bakr A, Farag SH. Prevention of lymphedema via axillary reverse mapping for arm lymph-node preservation following breast cancer surgery: a randomized controlled trial. Patient Saf Surg 2019; 13:35. [PMID: 31807140 PMCID: PMC6857341 DOI: 10.1186/s13037-019-0217-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/31/2019] [Indexed: 12/04/2022] Open
Abstract
Background Breast cancer, with an incidence of 32%, is the most frequent cancer among Egyptian women. The frequency of arm lymphedema after axillary surgery for breast cancer ranges from 7 to 77%. Axillary reverse mapping is a technique aimed to distinguish and conserve upper-limb lymphatics and lymph nodes during the course of axillary surgery and could help to prevent arm lymphedema. Methods Patients (n = 48) were prepared for axillary lymph-node dissection. The study group and the control group each contained 24 individuals. In the study group, following dye injection, stained arm lymph nodes and lymphatics were conserved during axillary dissection, whereas control-group participants underwent the conventional procedure. All participants were re-evaluated after 6 months, and the incidence of lymphedema was recorded by measuring arm circumference at a level 10 cm proximal to the medial epicondyle. Arm lymphedema was defined as a change in the circumference of the ipsilateral upper extremity > 2 cm during the follow-up period. Results Age, tumor size and N stage were not significantly different between the study and control groups. Lymph-node visualization was achieved in 20 participants (83.3%) in the study group. Suspicious stained lymph nodes were surgically removed from four individuals but showed no metastatic involvement. In 20 individuals in the study group, no stained lymph nodes were removed. The incidence of lymphedema in the control group was 16.7%, and the incidence in the study group was 4.2%. Conclusions Axillary reverse mapping is a minimally invasive technique that can be performed during axillary lymph-node dissection, helping to prevent the subsequent development of arm lymphedema. Trial registration #SCURCTN3276, retrospectively registered on 11 April 2017 at Research Ethics Committee at the Faculty of medicine-Suez Canal University.
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Affiliation(s)
- Mohammed Faisal
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Suez Canal University hospital, Circular Road, Ismailia, 411522 Egypt
| | - Mohamed Gamal Sayed
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Suez Canal University hospital, Circular Road, Ismailia, 411522 Egypt
| | - Kerolos Antonious
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Suez Canal University hospital, Circular Road, Ismailia, 411522 Egypt
| | - Ahmmed Abo Bakr
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Suez Canal University hospital, Circular Road, Ismailia, 411522 Egypt
| | - Sherif Hussein Farag
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Suez Canal University hospital, Circular Road, Ismailia, 411522 Egypt
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Li H, Jun Z, Zhi-Cheng G, Xiang Q. Factors that affect the false negative rate of sentinel lymph node mapping with methylene blue dye alone in breast cancer. J Int Med Res 2019; 47:4841-4853. [PMID: 31507208 PMCID: PMC6833398 DOI: 10.1177/0300060519827413] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective This study aimed to investigate the clinicopathological factors of the false negative rate (FNR) and accuracy of sentinel lymph node biopsy (SLNB) mapping with 1% methylene blue dye (MBD) alone, and to examine how to reduce the FNR in patients with breast cancer. Methods A total of 365 patients with invasive breast carcinoma who received axillary lymph node dissection after SLNB were retrospectively analyzed. SLNB was performed with 2 to 5 mL of 1% MBD. We studied the clinicopathological factors that could affect the FNR of SLNB. Results The identification rate of sentinel lymph nodes (SLNs) was 98.3% (359/365) and the FNR of SLNB was 10.4% (16/154). Multivariate analysis showed that the number of dissected SLNs and metastatic lymph nodes were independent predictive factors for the FNR of SLNB. The FNR in patients with 1, 2, 3, and ≥4 SLNs was 23.53%, 15.79%, 3.85%, and 1.79%, respectively. Conclusions SLNB mapping with MBD alone in patients with breast cancer can produce favorable identification rates. The FNR of SLNB decreases as the number of SLNs rises. Because of side effects of searching for additional SLNs and the FNR, removal of three or four SLNs may be appropriate.
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Affiliation(s)
- Huang Li
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Breast Surgery Ward No. 3, The Affiliated Tumor Hospital of Shanxi Medical University, Shanxi Tumor Hospital, Taiyuan, Shanxi, China
| | - Zhang Jun
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ge Zhi-Cheng
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qu Xiang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Brahma B, Putri RI, Karsono R, Andinata B, Gautama W, Sari L, Haryono SJ. The predictive value of methylene blue dye as a single technique in breast cancer sentinel node biopsy: a study from Dharmais Cancer Hospital. World J Surg Oncol 2017; 15:41. [PMID: 28173818 PMCID: PMC5297091 DOI: 10.1186/s12957-017-1113-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/01/2017] [Indexed: 01/25/2023] Open
Abstract
Background Axillary lymph node dissection (ALND) has been the standard treatment of breast cancer axillary staging in Indonesia. The limited facilities of radioisotope tracer and isosulfan or patent blue dye (PBD) have been the major obstacles to perform sentinel node biopsy (SNB) in our country. We studied the application of 1% methylene blue dye (MBD) alone for SNB to overcome the problem. Methods This prospective study enrolled 108 patients with suspicious malignant lesions or breast cancer stages I–III. SNB was performed using 2–5 cc of 1% MBD and proceeded with ALND. The histopathology results of sentinel nodes (SNs) were compared with axillary lymph nodes (ALNs) for diagnostic value assessments. Results There were 96 patients with invasive carcinoma from July 2012 to September 2014 who were included in the final analysis. The median age was 50 (25–69) years, and the median pathological tumor size was 3 cm (1–10). Identification rate of SNs was 91.7%, and the median number of the identified SNs was 2 (1–8). Sentinel node metastasis was found in 53.4% cases and 89.4% of them were macrometastases. The negative predictive value (NPV) of SNs to predict axillary metastasis was 90% (95% CI, 81–99%). There were no anaphylactic reactions, but we found 2 cases with skin necrosis. Conclusions The application of 1% MBD as a single technique in breast cancer SNB has favorable identification rates and predictive values. It can be used for axillary staging, but nevertheless the technique should be applied with attention to the tumor size and grade to avoid false negative results.
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Affiliation(s)
- Bayu Brahma
- Department of Surgical Oncology, Dharmais Cancer Hospital, Jalan. Let. Jend. S. Parman Kav. 84-86, Jakarta, 11420, Indonesia. .,Department of Surgical Oncology, Bogor City General Hospital, Jalan DR. Semeru No. 120, West Bogor, West Java, 16112, Indonesia.
| | - Rizky Ifandriani Putri
- Department of Anatomical Pathology, Dharmais Cancer Hospital, Jalan. Let. Jend. S. Parman Kav. 84-86, Jakarta, 11420, Indonesia
| | - Ramadhan Karsono
- Department of Surgical Oncology, Dharmais Cancer Hospital, Jalan. Let. Jend. S. Parman Kav. 84-86, Jakarta, 11420, Indonesia.,Departement of Surgical Oncology, Mochtar Riady Comprehensive Cancer Center (MRCCC) Siloam Hospital, Jalan Garnisun Dalam No. 2-3, Semanggi, Central Jakarta, 12930, Indonesia
| | - Bob Andinata
- Department of Surgical Oncology, Dharmais Cancer Hospital, Jalan. Let. Jend. S. Parman Kav. 84-86, Jakarta, 11420, Indonesia
| | - Walta Gautama
- Department of Surgical Oncology, Dharmais Cancer Hospital, Jalan. Let. Jend. S. Parman Kav. 84-86, Jakarta, 11420, Indonesia
| | - Lenny Sari
- Department of Anatomical Pathology, Dharmais Cancer Hospital, Jalan. Let. Jend. S. Parman Kav. 84-86, Jakarta, 11420, Indonesia
| | - Samuel J Haryono
- Department of Surgical Oncology, Dharmais Cancer Hospital, Jalan. Let. Jend. S. Parman Kav. 84-86, Jakarta, 11420, Indonesia.,Departement of Surgical Oncology, Mochtar Riady Comprehensive Cancer Center (MRCCC) Siloam Hospital, Jalan Garnisun Dalam No. 2-3, Semanggi, Central Jakarta, 12930, Indonesia
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10
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Ren L, Liu Z, Liang M, Wang L, Song X, Wang S. 10 % fluorescein sodium vs 1 % isosulfan blue in breast sentinel lymph node biopsy. World J Surg Oncol 2016; 14:280. [PMID: 27809854 PMCID: PMC5093998 DOI: 10.1186/s12957-016-1031-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 10/19/2016] [Indexed: 12/13/2022] Open
Abstract
Background Sentinel lymph node biopsy (SLNB) is well accepted to be a standard procedure in breast cancer surgery with clinically negative lymph nodes. Isosulfan blue is the first dye approved by the USA Food and Drug Administration for the localization of the lymphatic system. Few alternative tracers have been investigated. In this study, we aimed to compare the differences between 10 % fluorescein sodium and 1 % isosulfan blue in breast sentinel lymph node biopsy and to investigate the feasibility of using 10 % fluorescein sodium as a new dye for breast sentinel lymph node biopsy. Methods A total of 30 New Zealand rabbits were randomly divided into the fluorescein sodium group and the isosulfan blue group (15 rabbits per group). Fluorescein sodium or isosulfan blue was injected subcutaneously into the second pair of mammary areolas. Results The average fading time of the second lymph nodes in the isosulfan blue group was significantly shorter than that in the fluorescein sodium group. Moreover, the detection rates of SLNs were higher in the fluorescein sodium group than in the isosulfan blue group. No significant differences between the fluorescein sodium group and isosulfan blue group were observed regarding the distances between the detected sentinel lymph nodes and second pair of mammary areolas, the distances between the second lymph nodes and second pair of mammary areolas, the number of detected sentinel lymph nodes and second lymph nodes, the average dyeing time of the sentinel and the second lymph nodes, and the average fading time of the second lymph nodes. Conclusions In summary, we first reported that fluorescein sodium is a potential new tracer for breast sentinel lymph node biopsy.
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Affiliation(s)
- Lidong Ren
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.,Department of Breast Surgery, Inner Mongolia People's Hospital, Hohhot, China
| | - Zhao Liu
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.,Department of Thyroid and Breast Surgery, Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - Mengdi Liang
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Li Wang
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xingli Song
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Shui Wang
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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Alhussini MA, Awad AT, Ashour MH, Abdelateef A, Fayed H. Breast Cancer Sentinel Node Detection: An Alternative Solution for Centers Lacking Nuclear Technology. Breast Care (Basel) 2016; 11:265-268. [PMID: 27721714 DOI: 10.1159/000448409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sentinel lymph node (SLN) has become the gold standard for all cases with no axillary nodal metastasis. The combined radioisotope and blue dye technique is adopted in most centers. The lack of the technology for radioisotope in our institution encouraged us to study the feasibility of methylene blue (MB) for SLN detection in breast cancer patients admitted to Alexandria Surgical Oncology Unit. METHODS A total of 144 cases were subjected to SLN detection by injecting 2 ml of MB 1%. This was followed by standard axillary lymph node dissection. The safety and accuracy of MB as a tracer for detection of SLN were studied. RESULTS The identification rate was 93.15%. The number of SLN identified ranged from 1 to 8 nodes with a mean of 1.75 ± 1.17. The sensitivity of MB dye technique was 96.3%. The false negative rate was 3.7%. The negative predictive value was 97.6% and the accuracy was 98.5%. CONCLUSIONS MB is a safe, reliable, cheap, and accurate alternative tracer for detection of SLN.
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Affiliation(s)
- Mahmoud A Alhussini
- Surgical Oncology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt, Alexandria, Egypt
| | - Ahmed T Awad
- Surgical Oncology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt, Alexandria, Egypt
| | - Mohamed H Ashour
- Surgery Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Ahmed Abdelateef
- Surgical Oncology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt, Alexandria, Egypt
| | - Haytham Fayed
- Surgical Oncology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt, Alexandria, Egypt
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Li J, Zhuang Z, Jiang B, Zhao P, Lin C. Advances and perspectives in nanoprobes for noninvasive lymph node mapping. Nanomedicine (Lond) 2015; 10:1019-36. [PMID: 25867863 DOI: 10.2217/nnm.14.201] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Sentinel lymph node (SLN) biopsy is now being well accepted as a practical approach to determine axillary lymph node status. For SLN biopsy, the mapping of SLN is an important procedure. However, blue dyes and radioactive colloids used for clinical SLN mapping are associated with a few issues such as adverse side effects and short retention time in SLN. In recent years, nanoscale probes for noninvasive SLN mapping have received attention due to their adaptable synthesis methods, adjustable optical properties and good biocompatibility. This review thoroughly summarizes the design of the nanoprobes and their properties in SLN mapping. The aim is to understand the status of nanomaterials for SLN mapping, challenging work and potential clinical translation in the future.
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Affiliation(s)
- Jiejing Li
- Shanghai East Hospital, The Institute for Biomedical Engineering & Nanoscience, Tongji University School of Medicine, Tongji University, Shanghai, 200092, PR China
- Department of Breast Surgery, Shanghai First Maternity & Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, PR China
| | - Zhigang Zhuang
- Department of Breast Surgery, Shanghai First Maternity & Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, PR China
| | - Beiqi Jiang
- Department of Breast Surgery, Shanghai First Maternity & Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, PR China
| | - Peng Zhao
- Shanghai East Hospital, The Institute for Biomedical Engineering & Nanoscience, Tongji University School of Medicine, Tongji University, Shanghai, 200092, PR China
| | - Chao Lin
- Shanghai East Hospital, The Institute for Biomedical Engineering & Nanoscience, Tongji University School of Medicine, Tongji University, Shanghai, 200092, PR China
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Ratchaworapong K, Thanawut S, Yodavudh S, Chottanapund S. Rate of sentinel lymph node identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital, Thailand. ASIAN BIOMED 2014. [DOI: 10.5372/1905-7415.0804.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: The sentinel lymph node (SLN) is the first lymph node to receive lymphatic drainage from a primary breast tumor. If the SLN contains no metastatic tumor, then it is unlikely other lymph nodes will contain breast cancer metastasis. When the SLN does contains metastasis, an axillary lymph node dissection (ALND) is recommended to further stage the axilla and to maintain locoregional control. SLNs can be identified by using a dye, radioisotope, or combined techniques.
Objective: To determine the rate of SLN identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital, Thailand, and factors that affect it.
Methods: This prospective study of 106 consecutive cases breast cancer enrolled 105 women (1 bilateral breast cancer case) between October 2011 and October 2013 at Charoenkrung Pracharak Hospital. Clinical and pathological features were analyzed for the effectiveness of SLN identification using isosulfan blue dye.
Results: The rate of SLN identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital was 92%. The method was safe and well tolerated in early-stage breast cancer patients.
Conclusion: The effectiveness of sentinel node identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital is consistent with that shown in studies from other countries.
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Affiliation(s)
| | - Sarawut Thanawut
- Department of Surgery, Charoenkrung Pracharak Hospital, Thailand
| | - Sirisanpang Yodavudh
- Department of Pathology, Charoenkrung Pracharak Hospital, Bangkok 10120, Thailand
| | - Suthat Chottanapund
- Department of Surgery, Bamrasnaradura Infectious Diseases Institute, Nontaburi 10110, Thailand
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Methylene blue dye-induced skin necrosis in immediate breast reconstruction: evaluation and management. Arch Plast Surg 2014; 41:258-63. [PMID: 24883277 PMCID: PMC4037772 DOI: 10.5999/aps.2014.41.3.258] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 08/22/2013] [Accepted: 09/09/2013] [Indexed: 11/18/2022] Open
Abstract
Background For early breast cancer patients, skin-sparing mastectomy or nipple-sparing mastectomy with sentinel lymph node biopsy has become the mainstream treatment for immediate breast reconstruction in possible cases. However, a few cases of skin necrosis caused by methylene blue dye (MBD) used for sentinel lymph node localization have been reported. Methods Immediate breast reconstruction using a silicone implant was performed on 35 breasts of 34 patients after mastectomy. For sentinel lymph node localization, 1% MBD (3 mL) was injected into the subareolar area. The operation site was inspected in the postoperative evaluation. Results Six cases of immediate breast reconstruction using implants were complicated by methylene blue dye. One case of local infection was improved by conservative treatment. In two cases, partial necrosis and wound dehiscence of the incision areas were observed; thus, debridement and closure were performed. Of the three cases of wide skin necrosis, two cases underwent removal of the dead tissue and implants, followed by primary closure. In the other case, the breast implant was salvaged using latissimus dorsi musculocutaneous flap reconstruction. Conclusions The complications were caused by MBD toxicity, which aggravated blood disturbance and skin tension after implant insertion. When planning immediate breast reconstruction using silicone implants, complications of MBD should be discussed in detail prior to surgery, and appropriate management in the event of complications is required.
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Angarita FA, Acuna SA, Cervera S, Torregrosa L, Tawil M. Meeting Surgical Necessities for Sentinel Lymph Node Biopsy in Breast Cancer: Experience with Methylene Blue in a Colombian Hospital. Breast J 2012; 18:618-9. [DOI: 10.1111/tbj.12022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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An exploration of the surgical modality of sentinel lymph node biopsy in patients with cN0 tongue carcinoma: An animal study. ACTA ACUST UNITED AC 2011; 112:439-45. [DOI: 10.1016/j.tripleo.2010.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 11/03/2010] [Accepted: 11/08/2010] [Indexed: 11/17/2022]
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17
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Howard JD, Moo V, Sivalingam P. Anaphylaxis and other Adverse Reactions to Blue Dyes: A Case Series. Anaesth Intensive Care 2011; 39:287-92. [DOI: 10.1177/0310057x1103900221] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report three cases of anaphylaxis during anaesthesia confirmed on intradermal testing to be related to patent blue V dye (Guerbet – Chemical Abstract Service 3536-49-0). All three cases were associated with moderate to severe hypotension. Two cases had delayed onset, and two were associated with a rash. None of the cases were associated with bronchospasm. In all three patients the interference with pulse oximetry readings contributed to difficulties in management. We recommend the use of a test dose of blue dye prior to surgery, as suggested in the manufacturer's product information. We also recommend high vigilance for possible allergic reactions when patent blue dyes are used for sentinel lymph node mapping, because the presentations may be atypical and the reduced pulse oximetry readings may be a distraction.
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Affiliation(s)
- J. D. Howard
- Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - V. Moo
- Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - P. Sivalingam
- Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Lavaud F, Mouton C, Ponvert C. Les tests cutanés dans le bilan diagnostique des réactions d’hypersensibilité peranesthésiques. ACTA ACUST UNITED AC 2011; 30:264-79. [DOI: 10.1016/j.annfar.2010.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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19
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Kaklamanos IG, Birbas K, Syrigos K, Bonatsos VG, Bonatsos G. Prospective comparison of peritumoral and subareolar injection of blue dye alone, for identification of sentinel lymph nodes in patients with early stage breast cancer. J Surg Oncol 2011; 104:37-40. [DOI: 10.1002/jso.21897] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 01/28/2011] [Indexed: 11/05/2022]
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White V, Harvey JR, Griffith CDM, Youssef M, Carr M. Sentinel lymph node biopsy in early breast cancer surgery--working with the risks of vital blue dye to reap the benefits. Eur J Surg Oncol 2010; 37:101-8. [PMID: 21195576 DOI: 10.1016/j.ejso.2010.12.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 11/21/2010] [Accepted: 12/06/2010] [Indexed: 11/24/2022] Open
Abstract
AIMS Sentinel lymph node biopsy (SLNB) is an important method of staging early breast cancer because of the inherent benefits it confers on patients in terms of arm function and quality of life. Its success depends on a high level of accuracy in detecting the sentinel node. This is achieved by a dual mapping technique that employs a radio-labelled nanocolloid and a vital blue dye. The vital dyes however carry the risk of anaphylaxis, and as more surgeons employ SLNB in their daily practice, a proportionate rise in the number of anaphylactic reactions can be expected. A comprehensive review of risks and benefits associated with using vital blues dyes has not been published and therefore a retrospective review was undertaken of the different levels of anaphylaxis associated with vital dyes as well as their benefits in SLNB. METHODS An OVID MEDLINE search was performed of the English published literature using appropriate search terms to find published trial data and case series that focused on adverse reactions to vital blue dyes. RESULTS The risk of severe anaphylaxis (grade 3) can be as low as 0.06%, and up to 0.4% for patients undergoing SLNB when data is analysed from large trials. Furthermore, adverse reactions associated with blue dyes are reversible with appropriate management. CONCLUSIONS Surgeons should continue to use vital dyes to ensure that SLNB remains a highly sensitive procedure.
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Affiliation(s)
- V White
- Department of Breast Surgery, Wansbeck General Hospital, Woodhorn Lane, Ashington NE63 9JJ, United Kingdom.
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21
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Neves RI, Reynolds BQ, Hazard SW, Saunders B, Mackay DR. Increased post-operative complications with methylene blue versus lymphazurin in sentinel lymph node biopsies for skin cancers. J Surg Oncol 2010; 103:421-5. [PMID: 21400527 DOI: 10.1002/jso.21845] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 11/29/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SNLB) is the standard of care in staging of melanoma and other skin cancers. Early studies used lymphazurin (LZ) for SLNB. A national shortage of LZ promoted methylene blue (MB) as an alternate stain. OBJECTIVE This study compares complication rates between LZ and MB in SLNB patients, and the reliability dyes in locating sentinel lymph nodes. METHODS Charts were reviewed for patients who underwent SLNB for skin cancers between September 2006 and November 2008 at Penn State Hershey Medical Center. The type and quantity of dye, the presence of blue stained sentinel nodes, and any complications were recorded. RESULTS Ninety-three patients underwent SLNB (46 LZ, 47 MB). The amount of dye used was similar (avg. 0.93 ml LZ, 1.24 ml MB). The complication rate of LZ was 8.7%, and MB was 25.5%. There was significantly more (P = 0.003) skin graft complications in the MB patients (6/12) versus LZ (0/15). CONCLUSIONS There is a higher rate of complications with MB, especially with skin grafting. The reported risk of anaphylaxis with LZ has not been reported in volumes <2 ml. The sentinel lymph node identification rate is historically similar between dyes, and in this study was noted to be higher with LZ.
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Affiliation(s)
- Rogerio I Neves
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA.
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22
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Barthelmes L, Goyal A, Newcombe RG, McNeill F, Mansel RE. Adverse reactions to patent blue V dye - The NEW START and ALMANAC experience. Eur J Surg Oncol 2009; 36:399-403. [PMID: 19939618 DOI: 10.1016/j.ejso.2009.10.007] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 08/14/2009] [Accepted: 10/08/2009] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Blue dye with or without isotope has been widely used to identify the sentinel lymph node(s) in breast cancer. Patent blue V is used in the UK while its isomer isosulfan blue is used in the US. The allergic potential of isosulfan blue is well documented (1.4% adverse reactions) but that of patent blue V is less clearly defined. METHODS In this paper we review the adverse reactions of patent blue V in 7,917 patients who participated in the NEW START training programme and the ALMANAC trial. All patients underwent sentinel lymph node biopsy for breast carcinoma using patent blue V in combination with (99m)Tc-albumin colloid. RESULTS In total, 72 of 7,917 (0.9%) patients experienced adverse reactions : non-allergic reactions were observed in 4 (0.05%) patients, 23 (0.3%) patients had minor grade I allergic skin reactions (urticaria, blue hives, pruritus, or generalised rash) and 16 (0.2%) had grade II reactions (transient hypotension/bronchospasm/laryngospasm). Severe Grade III reactions (severe hypotension requiring vasopressor support and/or change/abandoning of planned procedure and/or HDU/ITU admission) were noted in 5 (0.06%) patients. The type of adverse reaction was not specified in 24 (0.3%) patients. No mortality was recorded. CONCLUSION The allergic potential of patent blue V dye compares favourably with isosulfan blue however both the surgeon and anaesthetist need to be alert to the risk of allergic reactions.
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Affiliation(s)
- L Barthelmes
- Department of Surgery, School of Medicine, Cardiff University, Cardiff, UK
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Jeon YH, Kim YH, Choi K, Piao JY, Quan B, Lee YS, Jeong JM, Chung JK, Lee DS, Lee MC, Lee J, Chung DS, Kang KW. In vivo imaging of sentinel nodes using fluorescent silica nanoparticles in living mice. Mol Imaging Biol 2009; 12:155-62. [PMID: 19830500 DOI: 10.1007/s11307-009-0262-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Revised: 03/19/2009] [Accepted: 04/28/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE We examine the feasibility of fluorescent imaging system for sentinel lymph node detection by using functionalized silica nanoparticles. MATERIALS AND METHODS We developed a functionalized RITC-SiO(2) nanoparticles containing fluorescent dye, C(28)H(31)N(2)O(3)Cl (rhodamine B isothiocyanate) inside, and subsequently synthesized (68)Ga-NOTA-RITC-SiO(2) nanoparticles. RESULTS At 5 min after RITC-doped silica nanoparticles injection, fluorescent signals were shown in both right axillary lymph node (ALN) and injection site of living mice. Fluorescent signals were also observed at these locations in a biodistribution study. In addition, fluorescence was detected in frozen ALN sections microscopically. The percentages of doses injected per gram of tissue of axillary and brachial lymph nodes near footpad treated with (68)Ga-NOTA-RITC-SiO(2) nanoparticles were 308.3 +/- 3.4 and 41.5 +/- 6.1, respectively. Little (68)Ga radioactivity was found in other organs. CONCLUSION Our data provide strong evidence that functionalized silica nanoparticles has a promising potential as organic lymphatic tracer in biomedical imaging such as pre- and intraoperative surgical guidance.
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Affiliation(s)
- Yong Hyun Jeon
- Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul, South Korea
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Bleicher RJ, Kloth DD, Robinson D, Axelrod P. Inflammatory cutaneous adverse effects of methylene blue dye injection for lymphatic mapping/sentinel lymphadenectomy. J Surg Oncol 2009; 99:356-60. [DOI: 10.1002/jso.21240] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Aydogan F, Salihoglu Z, Uras C, Karabicak I, Celik V, Cercel A, Baghaki S, Topuz U, Atasoy D, Babazade R, Unal H. Intraparenchymal Methylene Blue Injection for Sentinel Lymph Node Biopsy in Breast Cancer Patients does not Interfere with the Pulse Oximetry Readings. J Breast Cancer 2009. [DOI: 10.4048/jbc.2009.12.1.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Fatih Aydogan
- Department of General Surgery; Breast Division, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey
| | - Ziya Salihoglu
- Department of Anesthesiology and Reanimation, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey
| | - Cihan Uras
- Department of General Surgery; Breast Division, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey
| | - Ilhan Karabicak
- Department of General Surgery; Breast Division, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey
| | - Varol Celik
- Department of General Surgery; Breast Division, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey
| | - Ali Cercel
- Department of General Surgery; Breast Division, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey
| | - Semih Baghaki
- Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey
| | - Ufuk Topuz
- Department of Anesthesiology and Reanimation, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey
| | - Deniz Atasoy
- Department of General Surgery; Breast Division, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey
| | - Rovnat Babazade
- Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Hilal Unal
- Department of General Surgery; Breast Division, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey
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Zakaria S, Hoskin TL, Degnim AC. Safety and technical success of methylene blue dye for lymphatic mapping in breast cancer. Am J Surg 2008; 196:228-33. [PMID: 18367146 DOI: 10.1016/j.amjsurg.2007.08.060] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 07/30/2007] [Accepted: 08/08/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to evaluate the safety and efficacy of methylene blue dye (MBD) for sentinel lymph node (SLN) mapping in breast cancer. METHODS A total of 398 patients undergoing 401 SLN biopsy procedures with MBD were retrospectively reviewed and divided into 3 groups based on dye concentration and location of dye injection. Technical success and complication rates were compared. RESULTS Overall technical success of SLN biopsy was 99.7%. Technical success of SLN mapping with MBD was lowest in the group receiving full strength dye in a peritumoral location (74%) and highest in the group that received very dilute MBD (1.25 mg/mL) in the subareolar location (92%, P = .004). The complication rate was highest in the first group (21%) and lowest in the latter (2%, P = .0003). CONCLUSIONS Dilute MBD (1.25 mg/mL) successfully maps SLNs with very few complications.
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Affiliation(s)
- Shaheen Zakaria
- Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
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27
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Mertes PM, Malinovsky JM, Mouton-Faivre C, Bonnet-Boyer MC, Benhaijoub A, Lavaud F, Valfrey J, O'Brien J, Pirat P, Lalourcey L, Demoly P. Anaphylaxis to dyes during the perioperative period: Reports of 14 clinical cases. J Allergy Clin Immunol 2008; 122:348-52. [DOI: 10.1016/j.jaci.2008.04.040] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 04/05/2008] [Accepted: 04/30/2008] [Indexed: 10/22/2022]
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Varghese P, Abdel-Rahman AT, Akberali S, Mostafa A, Gattuso JM, Carpenter R. Methylene blue dye--a safe and effective alternative for sentinel lymph node localization. Breast J 2008; 14:61-7. [PMID: 18186867 DOI: 10.1111/j.1524-4741.2007.00519.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Sentinel lymph node (SLN) biopsy has emerged as an effective diagnostic tool in axillary staging in breast cancer. The commonly used technique employs isosulfan blue/patent blue V combined with radioactive colloid tracer. Methylene blue (MB) is a less expensive and readily available alternative dye. The study evaluated the safety and efficacy of MB in SLN localization. A retrospective study of 329 patients with early breast cancer who had SLN localization as part of an ethically approved prospective evaluation study of SLN localization technique was carried out. Lymph node positive, tumors >2 cm on clinical and radiological evaluation, those with previous breast and axillary surgery, neo-adjuvant chemotherapy were excluded from the study. One hundred seventy three patients underwent SLN localization using 1 mL of 1% MB, and a combined MB-radio colloid tracer technique was used in the other 156 patients. Allocation to the groups was by simple randomization. Injection of the dye and radioisotope was into the subdermal plane in the sub-areolar region. Patients underwent breast conservation surgery or mastectomy with SLN directed four node axillary sampling +/- axillary clearance. The lymph node was examined by standard microscopy. There were no reported complications with the use of MB aside from temporary tattooing. The technique failed in eight patients giving an identification rate of 97.6%. Ten of the 258 (3.9%) patients had false-negative SLN, with negative predictive value of 96.1%, sensitivity of predicting further axillary disease of 73%, specificity of 87.3%, and overall accuracy of 85.7%. Reported adverse reaction to isosulfan blue/patent blue V varied from minor to severe anaphylactic reactions (1-3%) requiring vigorous resuscitation. Subdermal sub-areolar injection of MB is safe and effective readily available dye for SLN localization in axillary staging of breast cancer with no major adverse reaction.
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Affiliation(s)
- Philip Varghese
- Breast Unit, St Bartholomew's Hospital, Queen Mary University of London, United Kingdom.
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Sato K. Current technical overviews of sentinel lymph node biopsy for breast cancer. Breast Cancer 2008; 14:354-61. [PMID: 17986800 DOI: 10.2325/jbcs.14.354] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Sentinel lymph node biopsy (SLNB) is based on the hypothesis that the sentinel lymph node (SLN) reflects the lymph-node status and a negative SLN might allow complete axillary lymph node dissection (ALND) to be avoided. Although the survival outcome is still unknown, this technique has already become a standard of care for breast cancer patients. However, it is still important to discuss current techniques and some controversies. This article reviews these issues for a variety of SLNB techniques.
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Affiliation(s)
- Kazuhiko Sato
- Department of Surgery, Self-Defense Forces Central Hospital, Setagaya, Tokyo, 154-8532, Japan.
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30
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Dauphine C, Vargas HI. Outcomes following sentinel lymph node biopsy for breast cancer. Expert Rev Pharmacoecon Outcomes Res 2007; 7:469-77. [PMID: 20528392 DOI: 10.1586/14737167.7.5.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Evaluation of axillary lymph nodes for metastatic involvement is the most significant factor in gauging prognosis in breast cancer patients. Complete axillary dissection can be associated with significant morbidity. Therefore, sentinel node biopsy was developed to sample nodes and avoid dissection in patients without clinical evidence of nodal involvement. While most surgeons currently perform the procedure, the technique remains unstandardized. Sentinel node identification rates, false-negative rates and procedural complication rates are the main outcomes measured and can depend significantly on variations in technique. Future studies on sentinel lymph node biopsy will probably focus on clarifying accuracy of the procedure in different clinical settings, delineating standard technical practice guidelines and further achieving improved outcomes.
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Affiliation(s)
- Christine Dauphine
- Harbor-UCLA Medical Center, 1000 West Carson St Box #25, Torrance, CA 90509, USA.
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31
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Masannat YA, Shaaban AM, Speirs V, Coast G, Jackson P, Horgan K, Hanby AM. Adverse effects of dyes used in sentinel node biopsy on immunocytochemical determination of hormone receptors in breast cancer cells. J Clin Pathol 2007; 60:730-2. [PMID: 17557875 PMCID: PMC1955060 DOI: 10.1136/jcp.2006.044974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Y A Masannat
- Department of General Surgery, The Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK.
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Newman EA, Newman LA. Lymphatic Mapping Techniques and Sentinel Lymph Node Biopsy in Breast Cancer. Surg Clin North Am 2007; 87:353-64, viii. [PMID: 17498531 DOI: 10.1016/j.suc.2007.01.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The axillary nodal status is accepted universally as the most powerful prognostic tool available for early stage breast cancer. The removal of level I and level II lymph nodes at axillary node dissection (ALND) is the most accurate method to assess nodal status, and it is the universal standard; however, it is associated with several adverse long-term sequelae. Lymphatic mapping with sentinel lymph node biopsy has emerged as an effective and safe alternative to the ALND for detecting axillary metastases. This article discusses some lymphatic mapping methodology.
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Affiliation(s)
- Erika A Newman
- Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0932, USA.
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Song HM, Lim YS, Jeong MH, Paik SM, Bong JG. The Experiences of Performing Sentinel Lymph Node Biopsies with the Use of Methylene Blue Dye in Patients with Invasive Breast Carcinoma. J Breast Cancer 2007. [DOI: 10.4048/jbc.2007.10.3.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hee-Moon Song
- Department of Surgery, Wallace Memorial Baptist Hospital, Busan, Korea
| | - Yang-Soo Lim
- Department of Surgery, Wallace Memorial Baptist Hospital, Busan, Korea
| | - Min-Hee Jeong
- Department of Pathology, Wallace Memorial Baptist Hospital, Busan, Korea
| | - Sun-Mi Paik
- Department of Radiology, Wallace Memorial Baptist Hospital, Busan, Korea
| | - Jin-Gu Bong
- Department of Surgery, Catholic University of Deagu, Deagu, Korea
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Lee S, Kim JA, Yu KE, Choi YJ, Kim JH, Nam SJ, Yang JH. Methylene Blue for Localization of Sentinel Lymph Nodes in Breast Cancer: A Comparison with Isosulfan Blue. J Breast Cancer 2007. [DOI: 10.4048/jbc.2007.10.2.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sanghoon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Ah Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki-En Yu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Jin Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Han Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok-Jin Nam
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Hyun Yang
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Masannat Y, Shenoy H, Speirs V, Hanby A, Horgan K. Properties and characteristics of the dyes injected to assist axillary sentinel node localization in breast surgery. Eur J Surg Oncol 2006; 32:381-4. [PMID: 16515852 DOI: 10.1016/j.ejso.2006.01.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Accepted: 01/26/2006] [Indexed: 12/20/2022] Open
Abstract
AIMS A review of the safety profile of dyes injected to assist in sentinel lymph node biopsy (SLNB) in breast cancer. METHODS A literature search was performed of the medline database 1966-2005 using the Ovid web Gateway detailing the words sentinel node, breast cancer, allergic reactions, blue dye, isosulfan blue, patent blue and methylene blue. RESULTS There are reported side-effects from the parenteral administration of dyes, which range from minor to life threatening in severity. There are differences between the dyes as regards their effects. These aspects are discussed. CONCLUSION Many dyes have been used for SLNB with acceptable identification rates. There are variable side-effects for each of those dyes. Further research is needed to clarify the safety profile of these dyes.
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Affiliation(s)
- Y Masannat
- The Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK.
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37
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Salhab M, Al sarakbi W, Mokbel K. Skin and fat necrosis of the breast following methylene blue dye injection for sentinel node biopsy in a patient with breast cancer. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2005; 2:26. [PMID: 16313674 PMCID: PMC1308848 DOI: 10.1186/1477-7800-2-26] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Accepted: 11/28/2005] [Indexed: 11/17/2022]
Abstract
Sentinel lymph node biopsy (SLNB) is a simple technique that uses subdermal or peri-tumoral injection of vital blue dye and/or radioactive isotope to identify the first lymph node(s) draining the primary tumor. It has been shown to accurately predict axillary node status in patients with clinically node negative breast cancer. The SLNB is emerging as a new standard of care in patients with early breast cancer. However, the use of methylene blue (MB) dye can be associated with a number of local complications due to its tissue reactive properties. We report a rare case of skin and fat necrosis followed by a dry gangrene of the skin in a female patient with breast cancer who underwent SLNB localization using peri-tumoral injection of MB dye in another institution. This case and literature review suggest that the use of MB dye for SLNB identification should be avoided and replaced with alternative types of blue dye such as Patent Blue V preferably in conjunction with a radioactive isotope tracer.
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Affiliation(s)
- M Salhab
- St Georges and The Princess Grace Hospitals, London, UK
| | - W Al sarakbi
- St Georges and The Princess Grace Hospitals, London, UK
| | - K Mokbel
- St Georges and The Princess Grace Hospitals, London, UK
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Kirszberg C, Rumjanek VM, Capella MAM. Methylene blue is more toxic to erythroleukemic cells than to normal peripheral blood mononuclear cells: a possible use in chemotherapy. Cancer Chemother Pharmacol 2005; 56:659-65. [PMID: 16052340 DOI: 10.1007/s00280-005-1014-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2004] [Accepted: 01/22/2005] [Indexed: 11/27/2022]
Abstract
Methylene blue (MB) is a phenothiazine with radio and photosensitizing properties and anti-tumoral activity. Our group has shown that MB was capable of inhibiting the in vitro growth of erythroleukemic cells with multidrug resistance (MDR). However, there are no studies comparing the cytotoxicity of this molecule for normal and tumoral cells. In this work, the cytotoxicity of MB was measured by MTT method in erythroleukemic and melanoma lineages, comparing it with that of normal cells:lymphocytes and melanocytes. MB was more cytotoxic for tumoral cells; however, there was no difference between erytroleukemic cells with or without MDR phenotype. Lymphocytes and erythroleukemic cells were much more sensitive to the effects of MB than melanoma cells and melanocytes. The proliferation of phytohemagglutinin-activated lymphocytes was inhibited when 3H-thymidine incorporation to DNA was measured. We tried to analyze whether the cells were dying, via apoptosis or necrosis, using Anexin-V and propidium iodide. Despite higher levels of Anexin-V, it was not possible to distinguish necrosis from apoptosis, as the fluorescence of MB is in the same channel as propidium iodide. The production of hydrogen peroxide was measured by cytometry using dihydrorhodamine 123 (DHR). Despite the erythroleukemic cells and lymphocytes being capable of producing free radicals, there was no relation between the production and the sensitivity of various cells to MB. Our results suggest that MB should be used as a chemotherapeutic agent, because of its preferential cytotoxic effects over tumor cells, considering the fact that MDR cells are also sensitive, and due to its radio and photosensitizing activities.
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Affiliation(s)
- C Kirszberg
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, CCS-Bloco G, 21949-900, Rio de Janeiro, RJ, Brazil
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Komenaka IK, Bauer VP, Schnabel FR, Horowitz E, Joseph KA, Ditkoff BA, El-Tamer MB. Allergic Reactions to Isosulfan Blue in Sentinel Lymph Node Mapping. Breast J 2005; 11:70-2. [PMID: 15647083 DOI: 10.1111/j.1075-122x.2005.21574.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy is often used in the assessment of lymph node status in melanoma and early stage breast cancer. With the rapidly increasing use of the technique, we can now better characterize and assess the rate of adverse reactions to the dye. METHODS A retrospective review of all patients undergoing SLN mapping at the Columbia-Presbyterian Breast Center were identified from June 2000 to July 2002. All patients who experienced allergic reactions were documented and records examined. RESULTS In total, three out of 351 patients had allergic complications from the procedure. All three patients developed "blue hives" after injection with isosulfan blue. The incidence at our Breast Center was 0.9%. All were treated with intravenous corticosteroids and diphenhydramine and recovered within twenty-four hours. CONCLUSIONS The increasing utilization of the sentinel lymph node technique will make these complications more common. A high index of suspicion and appropriate clinical management are recommended to minimize the potential morbidity of these reactions.
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Affiliation(s)
- Ian K Komenaka
- Section of Breast Surgery, Columbia-Presbyterian Medical Center, Columbia University, New York, New York 10032, USA.
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40
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Braat AE, Oosterhuis JWA, Moll FCP, de Vries JE. Successful sentinel node identification in colon carcinoma using Patent Blue V. Eur J Surg Oncol 2004; 30:633-7. [PMID: 15256237 DOI: 10.1016/j.ejso.2004.03.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2004] [Indexed: 01/22/2023] Open
Abstract
AIM The aim of this study was to evaluate the use of Patent Blue V for identification of the sentinel node in patients with colon carcinoma. METHOD From May 2002, 35 patients operated for colon carcinoma underwent lymphatic mapping using Patent Blue V as marker. Either directly after resection of the colon or during operation 2 ml of Patent Blue V was injected peritumourally, and the first 1 to 4 blue nodes were marked as sentinel nodes. Pathological evaluation was done on a single HE-stained section of all lymph nodes. Only if all sentinel nodes were negative for metastases, serial sectioning and additional immunohistochemical staining against keratine CK 7/8 was performed to reveal micrometastasis in the sentinel nodes. RESULTS In 33/35 of patients at least one sentinel node was identified. In 10/33 the sentinel node was positive for metastases, and in 5/10 this was the only node containing metastases. One patient had a false negative sentinel node (accuracy 97%, sensitivity 91%). CONCLUSION Using Patent Blue V, it is possible to identify the sentinel node in most patients with colon cancer. The results are comparable with other sentinel node studies using Lymphazurin.
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Affiliation(s)
- A E Braat
- Department of Surgery, Isala klinieken, locatie Sophia, Dokter van Heesweg 2, P.O. Box 10400, 8000 GK Zwolle, The Netherlands.
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Abstract
Sentinel lymph node biopsy (SLNB) is an important surgical advance in the management of early breast cancer. Localization of the sentinel lymph node (SLN) in breast cancer and other cancer patients is widely used now utilizing isosulfan blue dye. Few alternative types of dye have been used and investigated. In a prospective study of 54 patients, methylene blue dye was used as an alternative to isosulfan blue to localize the SLN in breast cancer patients. The methylene blue dye technique was successful in 91.1% of patients after excluding the initial learning cases; the results are similar for isosulfan blue dye. This study describes methylene blue dye localization as a successful alternative to isosulfan blue dye in identifying the sentinel node in breast cancer patients. Methylene blue dye is readily available in most Egyptian institutes, with a very low cost.
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Affiliation(s)
- Ashraf Nour
- Department of Surgery, Menoufiya University, Shebin-el-kom, Egypt.
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Merson M, Fenaroli P, Gianatti A, Virotta G, Giuliano LG, Bonasegale A, Bambina S, Pericotti S, Guerra U, Tondini C. Sentinel node biopsy in the surgical management of breast cancer: experience in a general hospital with a dedicated surgical team. Breast 2004; 13:200-5. [PMID: 15177422 DOI: 10.1016/j.breast.2004.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2003] [Revised: 11/25/2003] [Accepted: 01/20/2004] [Indexed: 10/26/2022] Open
Abstract
The aims of this study were to analyse the feasibility and accuracy of the sentinel lymph node biopsy (SLNB) procedure as performed in a general hospital compared with the literature results; to report on the organizational aspects of planning surgical time with higher accuracy of pathological analysis; and to verify that there is a real advantage of SLNB in the surgical management of breast cancer. From October 1999 to September 2000, 371 consecutive patients with T1-2N0 breast lesions underwent SLNB. The immunoscintigraphic method of sentinel node identification was the main one used, the blue dye method being used only when the lymphoscintigraphic method was unsuccessful in identifying sentinel nodes. SLNB was done under either general or local anaesthesia, depending on how the surgical procedure was organized and clinically planned. SLNB was successful in 99% of these T1-2N0 breast cancer cases, and in 71% no metastases were found in the sentinel node. In 47% of cases with axillary metastasis only the sentinel node was involved. Nodal involvement was not present in any case of microinvasive or in situ carcinoma. In T1 cancers nodal involvement was present in 21%; in T2 cases the corresponding rate reached 51%. The results obtained with the SLNB procedure at Bergamo Hospital are similar to the literature data. When a dedicated surgical team, the nuclear medicine department and the pathology department work together, a general hospital can provide breast cancer patients with appropriate surgical treatment.
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Affiliation(s)
- M Merson
- Breast Cancer Unit, Ospedali Riuniti, Largo Barozzi 1, 24128 Bergamo, Italy.
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43
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Kelley MC, Hansen N, McMasters KM. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Am J Surg 2004; 188:49-61. [PMID: 15219485 DOI: 10.1016/j.amjsurg.2003.10.028] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Lymphatic mapping and sentinel lymphadenectomy has become an important tool for axillary lymph node staging in women with early-stage breast cancer. This review examines data regarding the staging accuracy, indications and technical aspects of the procedure, and clinical trials investigating the technique. Multiple studies now confirm that sentinel lymphadenectomy accurately stages the axilla and is associated with less morbidity than axillary dissection. Blue dye, radiocolloid, or both can be used to identify the sentinel node, and several injection techniques may be used successfully. Many patient factors previously thought to affect accuracy of the procedure have now been shown to be of limited significance. The indications for the procedure are expanding, and the histopathologic evaluation of the sentinel node and the role of lymphoscintigraphy have been clarified. Clinical trials are now underway that will determine the prognostic significance of micrometastases and the therapeutic benefit of axillary dissection in women with and without sentinel node metastases. Incorporation of sentinel lymphadenectomy into routine clinical practice will maintain accurate axillary staging with lower morbidity and improved quality of life for women with early-stage breast cancer.
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Affiliation(s)
- Mark C Kelley
- Vanderbilt University Medical Center, Nashville, TN, USA
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44
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Singh-Ranger G, Mokbel K. Capsular contraction following immediate reconstructive surgery for breast cancer - An association with methylene blue dye. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2004; 1:3. [PMID: 15285809 PMCID: PMC483033 DOI: 10.1186/1477-7800-1-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2004] [Accepted: 05/11/2004] [Indexed: 11/21/2022]
Abstract
Capsular contraction following implantation of breast prostheses occurs in 2–33% of patients undergoing breast augmentation. This condition can be debilitating for patients, and often requires revisional surgery. The aetiology of capsular contraction is unclear, but may be due to infection, haematoma or foreign body-type reactions. Methylene blue dye is a substance known to cause localised tissue inflammation, and is often used during breast cancer surgery to allow identification of the sentinel lymph node. We report a case of Baker Grade 4 capsular contraction necessitating revisional surgery, occurring in a patient who underwent immediate breast reconstruction during surgery for breast cancer. Methylene blue dye was used to locate the sentinel nodes during the original surgery, and was found to have heavily discoloured the prosthesis at subsequent revisional surgery. Capsular contraction may have been caused in part by a localised tissue reaction initiated by, or involving the dye.
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Affiliation(s)
| | - Kefah Mokbel
- Breast Surgery Unit St. George's Hospital and Medical School, London, England, UK
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45
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Piñero A, Illana J, José Galindo P, Nicolás F, Parrilla P. Estudio comparativo entre el azul de isosulfán y el azul de metileno para la identificación del ganglio centinela en el cáncer de mama. Cir Esp 2004. [DOI: 10.1016/s0009-739x(04)72282-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Simmons R, Thevarajah S, Brennan MB, Christos P, Osborne M. Methylene blue dye as an alternative to isosulfan blue dye for sentinel lymph node localization. Ann Surg Oncol 2003; 10:242-7. [PMID: 12679308 DOI: 10.1245/aso.2003.04.021] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Our study describes the use of methylene blue dye as an alternative to isosulfan blue dye to identify the sentinel lymph node (SLN). METHODS A retrospective analysis was performed of 112 breast cancer patients (113 axillae) who underwent SLN biopsy (SLNB) with methylene blue dye and (99m)Tc-labeled sulfur colloid for SLN identification. All SLNs were submitted for intraoperative frozen section analysis, hematoxylin and eosin stain, and immunohistochemical evaluation. Patients with a pathologically negative SLN did not undergo further axillary lymph node dissection. RESULTS Of 112 patients who underwent SLNB, the SLN was identified in 107 (95.5%); 104 (92.8%) were identified by methylene blue dye. In a subset of 99 patients with recorded isotope status in relation to blue nodes, concordant identification with both dye and isotope was observed in 94 (94.9%). Of patients with identified SLNs, 32 (29.9%) of 107 contained metastatic disease, with 31 (96.9%) of 32 identified by methylene blue dye. The SLN was the only positive node in 18 (60.0%) of 30 patients. CONCLUSIONS SLNB with methylene blue dye is an effective alternative to isosulfan blue dye for accurately identifying SLNs in breast cancer patients.
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Affiliation(s)
- Rache Simmons
- Department of Surgery, New York Presbyterian Hospital, the Weill Cornell Medical College, New York, New York 10021, USA.
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47
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N/A. N/A. Shijie Huaren Xiaohua Zazhi 2003; 11:120-122. [DOI: 10.11569/wcjd.v11.i1.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Stradling B, Aranha G, Gabram S. Adverse skin lesions after methylene blue injections for sentinel lymph node localization. Am J Surg 2002; 184:350-2. [PMID: 12383900 DOI: 10.1016/s0002-9610(02)00945-5] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Methylene blue dye (MBD) is being used as an alternative to isosulfan blue dye in sentinel lymph node (SLN) biopsies for breast cancer patients. Complications using MBD for SLN localization have not previously been reported. METHODS A retrospective study was conducted of 24 consecutive patients who received MBD. Patients were given 3 to 5 cc of 1% MBD as peritumoral injections within the breast parenchyma and intradermally. Patients who developed local skin lesions at the injection site were queried regarding lesion appearance and when subsequent adjuvant therapy was initiated. RESULTS Five of the 24 patients (21%) developed skin lesions at the injection site. Intradermal injections were discontinued, and only deep parenchymal injections were performed. All 5 patients had improvement of their skin lesions with silver sulfadiazine cream and no patient required debridement. Each patient received adjuvant therapy after surgery without delay. CONCLUSIONS Our institution has experienced patients who developed skin lesions at the MBD injection site when using combined deep parenchymal and intradermal injections. With the increased use of MBD, caution should be used to avoid intradermal injections with SLN localization.
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Affiliation(s)
- Benjamin Stradling
- Chicago College of Osteopathic Medicine of Midwestern University, Chicago, IL, USA
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49
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Blessing WD, Stolier AJ, Teng SC, Bolton JS, Fuhrman GM. A comparison of methylene blue and lymphazurin in breast cancer sentinel node mapping. Am J Surg 2002; 184:341-5. [PMID: 12383897 DOI: 10.1016/s0002-9610(02)00948-0] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND When lymphazurin became unavailable to our institution, we elected to employ methylene blue to perform sentinel node mapping for patients with breast cancer. The purpose of this study was to compare methylene blue and lymphazurin for performing sentinel node mapping for breast cancer. METHODS We evaluated our sentinel node mapping experience from April 1, 2001 to March 31, 2002. Patients were divided into two groups based on the dye used for lymphatic mapping. The two groups were compared to evaluate the results of the sentinel node mapping procedure. RESULTS During the study period a total of 199 patients were evaluated with sentinel node mapping, 87 with lymphazurin and 112 with methylene blue. The two groups were similar in demonstrating the success of the sentinel node procedure, nodes identified per case, and technique used for node identification (colloid or dye, or both). CONCLUSIONS In our initial experience, methylene blue appears to be equivalent to lymphazurin for sentinel node mapping in breast cancer.
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Affiliation(s)
- Walter D Blessing
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA 70121, USA
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