Sentinel lymph node biopsy for breast cancer using methylene blue: a new anatomical landmark involving intercostobrachial and medial pectoral nodes

BACKGROUND Sentinel lymph node biopsy (SLNB) using blue dye is becoming popular in Indonesia given that knowledge on new anatomical landmarks involving intercostobrachial and medial pectoral nodes have replaced the need for radioisotope tracers. This study aimed to evaluate the utility of the proposed landmark involving intercostobrachial and medial pectoral nodes to determine axillary lymph node status during SLNB. METHODS A prospective study was conducted involving 55 patients with early-stage breast cancer who had clinically negative lymph nodes (T1T2, cN0) between 2018 and 2019 at Cipto Mangunkusumo Hospital. During SLNB, methylene blue 1% was injected at the subareolar area to identify intercostobrachial and medial pectoral nodes followed by axillary lymph node dissection (ALND). Histopathological results of sentinel nodes (SNs) were then compared to those of other axillary nodes. RESULTS SNs were identified in 54 patients (98%), 33 (61%) of whom had both intercostobrachial and medial pectoral SNs. Among patients with SNs, there were 1 patient without intercostobrachial SNs, 10 patients without medial pectoral SNs, and 1 patient with medial pectoral SNs but no intercostobrachial SNs. Accordingly, SNs had a negative predictive value (NPV) of 96.77% for axillary metastasis (95% confidence interval = 81.5499.51), with a false negative rate of 4.7%. No serious adverse events was observed. CONCLUSIONS The high identification rate and NPV, as well as the low false negative rate of the new anatomical landmark involving intercostobrachial and medial pectoral nodes during SLNB, suggest its reliability in determining axillary lymph node status.

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Sentinel Node Mapping for Breast Cancer: Current Situation

Journal of Oncology ◽

10.1155/2012/361341 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 22

Author(s):

Sergi Vidal-Sicart ◽

Renato Valdés Olmos

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Sentinel Node ◽

False Negative ◽

False Negative Rate ◽

Lymph Node Biopsy ◽

Axillary Lymph ◽

Node Dissection ◽

Node Biopsy

Axillary node status is a major prognostic factor in early-stage disease. Traditional staging needs levels I and II axillary lymph node dissection. Axillary involvement is found in 10%–30% of patients with T1 (<2 cm) tumours. Sentinel lymph node biopsy is a minimal invasive method of checking the potential nodal involvement. It is based on the assumption of an orderly progression of lymph node invasion by metastatic cells from tumour site. Thus, when sentinel node is free of metastases the remaining nodes are free, too (with a false negative rate lesser than 5%). Moreover, Randomized trials demonstrated a marked reduction of complications associated with the sentinel lymph node biopsy when compared with axillary lymph node dissection. Currently, the sentinel node biopsy procedure is recognized as the standard treatment for stages I and II. In these stages, this approach has a positive node rate similar to those observed after lymphadenectomy, a significant decrease in morbidity and similar nodal relapse rates at 5 years. In this review, the indications and contraindications of the sentinel node biopsy are summarized and the methodological aspects discussed. Finally, the new technologic and histologic developments allow to develop a more accurate and refinate technique that can achieve virtually the identification of 100% of sentinel nodes and reduce the false negative rate.

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Positive axillary lymph node status pre-neoadjuvant chemotherapy (NACT) is associated with a high rate of post-NACT sentinel lymph node biopsy positivity

10.26226/morressier.5b4709876f4cb30010951abe ◽

2018 ◽

Author(s):

Kate Dinneen ◽

David Gibbons

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Neoadjuvant Chemotherapy ◽

Lymph Node Biopsy ◽

High Rate ◽

Lymph Node Status ◽

Axillary Lymph ◽

Axillary Lymph Node Status ◽

Node Biopsy

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Sentinel lymph node biopsy after neoadjuvant chemotherapy predicts pathological axillary lymph node status in breast cancer patients with clinically positive axillary lymph nodes at presentation

International Journal of Clinical Oncology ◽

10.1007/s10147-012-0418-4 ◽

2012 ◽

Vol 18 (3) ◽

pp. 547-553 ◽

Cited By ~ 12

Author(s):

Hiroyuki Takei ◽

Takashi Yoshida ◽

Masafumi Kurosumi ◽

Kenichi Inoue ◽

Hiroshi Matsumoto ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Lymph Node Biopsy ◽

Axillary Lymph Nodes ◽

Lymph Node Status ◽

Axillary Lymph ◽

Axillary Lymph Node Status ◽

Breast Cancer Patients ◽

Node Biopsy

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Intraoperative Frozen Section Assessment of Sentinel Lymph Node Biopsy in Breast Carcinoma to Determine the Axillary Lymph Node Status

Annals of Pathology and Laboratory Medicine ◽

10.21276/apalm.2066 ◽

2018 ◽

Vol 5 (11) ◽

pp. A861-865

Author(s):

Ramawatar R Soni ◽

Aishwarya Vinod Bhongade ◽

Anil T Deshmukh ◽

Rajendrasingh S Arora ◽

Nafees Nomaan ◽

...

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Breast Carcinoma ◽

Frozen Section ◽

Lymph Node Biopsy ◽

Lymph Node Status ◽

Axillary Lymph ◽

Axillary Lymph Node Status ◽

Node Biopsy

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Sentinel Lymph Node Evaluation: What the Radiologist Needs to Know

Diagnostics ◽

10.3390/diagnostics9010012 ◽

2019 ◽

Vol 9 (1) ◽

pp. 12 ◽

Cited By ~ 2

Author(s):

Gary Whitman ◽

Raya AlHalawani ◽

Niloofar Karbasian ◽

Rajesh Krishnamurthy

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Axillary Lymph Node ◽

Prognostic Indicator ◽

Lymph Node Biopsy ◽

Lymph Node Status ◽

Axillary Lymph ◽

Node Biopsy

Axillary lymph node status is the single most important prognostic indicator in patients with breast cancer. Axillary lymph node dissection, the traditional method of staging breast cancer, is associated with significant morbidity. Sentinel lymph node biopsy has become standard in patients being treated for breast cancer with clinically negative lymph nodes. There is considerable variation in the medical literature regarding technical approaches to sentinel lymph node biopsy in patients with breast cancer. The purpose of this article is to describe our preferred approaches to sentinel lymph node biopsy with a review of the literature.

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Sentinel Node Biopsy after Neoadjuvant Chemotherapy for Breast Cancer: Preliminary Experience with Clinically Node Negative Patients after Systemic Treatment

Journal of Personalized Medicine ◽

10.3390/jpm11030172 ◽

2021 ◽

Vol 11 (3) ◽

pp. 172

Author(s):

Alejandro Martin Sanchez ◽

Daniela Terribile ◽

Antonio Franco ◽

Annamaria Martullo ◽

Armando Orlandi ◽

...

Keyword(s):

Lymph Node ◽

False Negative ◽

Neoadjuvant Treatment ◽

Disease Free Survival ◽

Lymph Node Biopsy ◽

Axillary Lymph ◽

Free Survival ◽

Oncological Outcomes ◽

Node Biopsy ◽

Disease Free

Sentinel lymph node biopsy (SLNB) following neoadjuvant treatment (NACT) has been questioned by many studies that reported heterogeneous identification (IR) and false negative rates (FNR). As a result, some patients receive axillary lymph node dissection (ALND) regardless of response to NACT, leading to a potential overtreatment. To better assess reliability and clinical significance of SLNB status on ycN0 patients, we retrospectively analyzed oncological outcomes of 399 patients treated between January 2016 and December 2019 that were either cN0-ycN0 (219 patients) or cN1/2-ycN0 (180 patients). The Endpoints of our study were to assess, furthermore than IR: oncological outcomes as Overall Survival (OS); Distant Disease Free Survival (DDFS); and Regional Disease Free Survival (RDFS) according to SLNB status. SLN identification rate was 96.8% (98.2% in patients cN0-ycN0 and 95.2% in patients cN+-ycN0). A median number of three lymph nodes were identified and removed. Among cN0-ycN0 patients, 149 (68%) were confirmed ypN0(sn), whereas regarding cN1/2-ycN0 cases 86 (47.8%) confirmed an effective downstaging to ypN0. Three year OS, DDFS and RDFS were significantly related to SLNB positivity. Our data seemed to confirm SLNB feasibility following NACT in ycN0 patients, furthermore reinforcing its predictive role in a short observation timing.

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489 The Role of Sentinel Lymph Node Biopsy in Cutaneous Head and Neck Melanoma: A Systematic Review and Meta-Analysis

British Journal of Surgery ◽

10.1093/bjs/znab134.289 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

E Johnston ◽

S Taylor ◽

F Bannon ◽

S McAllister

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Head And Neck ◽

False Negative ◽

False Negative Rate ◽

Lymph Node Biopsy ◽

Node Biopsy ◽

Negative Rate ◽

Sentinel Node Identification

Abstract Introduction and Aims The aim of this systematic review is to provide an up-to-date evaluation of the role and test performance of sentinel lymph node biopsy (SLNB) in the head and neck. Method This review follows the PRISMA guidelines. Database searches for MEDLINE and EMBASE were constructed to retrieve human studies published between 1st January 2010 and 1st July 2020 assessing the role and accuracy of sentinel lymph node biopsy in cutaneous malignant melanoma of the head and neck. Articles were independently screened by two reviewers and critically appraised using the MINORS criteria. The primary outcomes consisted of the sentinel node identification rate and test-performance measures, including the false-negative rate and the posttest probability negative. Results A total of 27 studies, including 4688 patients, met the eligibility criteria. Statistical analysis produced weighted summary estimates for the sentinel node identification rate of 97.3% (95% CI, 95.9% to 98.6%), the false-negative rate of 21.3% (95% CI, 17.0% to 25.4%) and the posttest probability negative of 4.8% (95% CI, 3.9% to 5.8%). Discussion Sentinel lymph node biopsy is accurate and feasible in the head and neck. Despite technical improvements in localisation techniques, the false negative rate remains disproportionately higher than for melanoma in other anatomical sites.

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Evaluating One Day versus Two Days Preoperative Lymphoscintigraphy Protocols for Sentinel Lymph Node Biopsy in Breast Cancer

The American Surgeon ◽

10.1177/000313481508100524 ◽

2015 ◽

Vol 81 (5) ◽

pp. 454-457 ◽

Cited By ~ 3

Author(s):

Michael G. Mount ◽

Nicholas R. White ◽

Christophe L. Nguyen ◽

Richard K. Orr ◽

Robert B. Hird

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Axillary Lymph Node ◽

Lymph Node Biopsy ◽

Axillary Lymph ◽

Axillary Lymph Node Metastases ◽

Node Biopsy ◽

Node Negative Breast Cancer

Sentinel lymph node biopsy (SLNB) is used to detect axillary lymph node metastases in breast cancer. Preoperative radiocolloid injection with lymphoscintigraphy (PL) is performed before SLNB. Few comparisons between 1- and 2-day PL protocols exist. Opponents of a 2-day protocol have expressed concerns of radiotracer washout to nonsentinel nodes. Proponents cite lack of scheduling conflicts between PL and surgery. A total of 387 consecutive patients with clinically node-negative breast cancer underwent SLNB with PL. Lymphoscintigraphy images were obtained within 30 minutes of radio-colloid injection. Axillary lymph node dissection was performed if the sentinel lymph node (SLN) could not be identified. Data were collected regarding PL technique and results. In all, 212 patients were included in the 2-day PL group and 175 patients in the 1-day PL group. Lymphoscintigraphy identified an axillary sentinel node in 143/212 (67.5%) of patients in the 2-day group and 127/175 (72.5%) in the 1-day group ( P = 0.28). SLN was identified at surgery in 209/212 (98.6%) patients in the 2-day group and 174/175 (99.4%) in the 1-day group ( P = 0.41). An average of 3 SLN was found at surgery in the 2-day group compared with 3.15 in the 1-day group ( P = 0.43). SLN was positive for metastatic disease in 54/212 (25.5%) patients in the 2-day group compared with 40/175 (22.9%) in the 1-day group ( P = 0.55). A 2-day lymphoscintigraphy protocol allows reliable detection of the SLN, of positive SLN and equivalent SLN harvest compared with a 1-day protocol. The timing of radiocolloid injection before SLNB can be left at the discretion of the surgeon.

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