👉Krag et al. first described using technetium-99m sulfur colloid in sentinel node (SN) mapping and noted that he attained an SN identification rate of 98%, with a false-negative rate of 11%.
👉Technetium-99m sulfur colloid is the most widely used radioisotope for lymphatic mapping in the United States.
👉In Europe, technetium-99m colloid albumin is used most often.
👉Similarly, Giuliano et al. described the use of isosulfan blue dye, with a SN detection rate of 98%, without false-negative nodes.
👉Anaphylaxis and hypotension also have been reported as adverse events when using isosulfan blue dye.
👉Overall, isosulfan blue dye is the most commonly used dye for the lymphatic mapping of breast cancer.
👉The SN detection rate using methylene blue has been described as 93%, and concordance with radioisotope was described in 95% of patients.
👉Although methylene blue is available at a lower cost when compared to isosulfan blue, it must be injected carefully into the subcutaneous tissues.
👉Injection into the dermis may lead to epidermolysis and necrosis.
👉Therefore when used, methylene blue should be diluted with saline to minimize these complications (eg, 1 ml of 1% methylene blue diluted with 2 to 3 ml of injectable saline) and injected in the subareolar breast parenchyma deep to the skin.
👉The combination of blue dye and radioisotope improves the SN detection rate as first described by Albertini and colleagues.
👉As a result, several other studies have demonstrated similar findings and, thus, dual-agent lymphatic mapping has been accepted universally as a better method in the detection of the SN.
👉The National Surgical Adjuvant Breast and Bowel Project (NSABP) B-32 used radioisotope and blue dye for the detection of SLNs.
👉Sentinel nodes were identified by blue dye alone in 5.1%, by radioisotope alone in 24.3% and by both tracers in 65.1% of patients.
👉The reported SLN identification rate was 97% with a 9.8% false-negative rate.
The most common adverse events were allergic reactions.
👉Anaphylaxis was also reported as an adverse event.
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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;196:228-233.
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