Comparison of blue dye, lymphoscintigraphy and intraoperative gamma probe, and combined technique for sentinel lymph node biopsy in breast cancer
Volkan Genç1, Özlem Küçük2, Atilla Halil Elhan3, Serpil Dizbay Sak4, Ragıp Çam1
1Ankara Üniversitesi Tıp Fakültesi Genel Cerrahi A.D,
2Ankara Üniversitesi Tıp Fakültesi Nükleer Tıp A.D,
3Ankara Üniversitesi Tıp Fakültesi Biyoistatistik A.D,
4Ankara Üniversitesi Tıp Fakültesi Patoloji A.D,
Purpose: Determination of lymphatic spread is the most important prognostic factor in breast cancer. The concept of sentinel lymph node dissection was introduced to determine the status of the lymph nodes in axilla without dissection. We searched which technique is more effective and correct.
Materials and Methods: Vital dye, lymphoscintigraphy + intraoperative gamma probing; and combined techniques were performed randomized on 3 groups made of 20 patients. Patent blue violet was used as vital dye and 1 ml each was injected to 4 quadrants surrounding the tumor and also subdermally. Albumin marked with Tc 99m sulphur colloid total 1 ml(200 MBq) was used as isotope and injected to the 4 surrounding quadrants again. During operation intraoperative gamma probing was used in 2nd and 3rd groups. The lymph node that has a minimum 10 fold value from the background measurement was accepted as sentinel lymph node. The obtained lymph nodes analyzed using routine hematoxylin and eosin study and immunohistochemical study.
Results: In vital dye group, the rate of identification was 85% and false negative rate of 16,7%. The rates were 95%, 0% in lymphoscintigraphy + intraoperative gamma probing group and 100%, 0% in combined group, respectively.
Conclusions: We determined % 100 identification rate in combined group due to applicating 5 ml. blue dye to peritumorally + subdermally and applicating 1 ml. isotope to peritumorally. We propose to combine technique with this applicating road for sentinel lymph node biopsy.
Keywords: Sentinel lymph node, lymphoscintigraphy, intraoperative gamma probe, breast cancer.