The predictive value of methylene blue dye as a single technique in breast cancer sentinel node biopsy: a study from Dharmais Cancer Hospital

Bayu Brahma, Rizky Ifandriani Putri, Ramadhan Karsono, Bob Andinata, Walta Gautama, Lenny Sari, Samuel J Haryono, Bayu Brahma, Rizky Ifandriani Putri, Ramadhan Karsono, Bob Andinata, Walta Gautama, Lenny Sari, Samuel J Haryono

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.

Keywords: Axillary lymph node; Breast cancer; Methylene blue dye; Sentinel node.

Figures

Fig. 1
Fig. 1
Patients flowchart for recruitment and SN assessment to predict axillary metastasis. SNs sentinel nodes, NSNs non-sentinel nodes, Mets metastasis

References

    1. Suzanna E, Sirait T, Rahayu PS, et al. Registrasi kanker berbasis rumah sakit di rumah sakit kanker “Dharmais”-pusat kanker nasional, 1993-2007. Indonesian J Cancer. 2012;6:179–205.
    1. Youlden DR, Cramb SM, Yip CH, Baade PD. Incidence and mortality of female breast cancer in the Asia-Pacific region. Cancer Biol Med. 2014;11(2):101–15.
    1. Giuliano AE, Han SH. Local and regional control in breast cancer: role of sentinel node biopsy. Adv Surg. 2011;45:101–16. doi: 10.1016/j.yasu.2011.03.015.
    1. D’Angelo-Donovan DD, Dickson-Witmer D, Petrelli NJ. Sentinel lymph node biopsy in breast cancer: a history and current clinical recommendations. Surg Oncol. 2012;21:196–200. doi: 10.1016/j.suronc.2011.12.005.
    1. McLaughlin SA, Wright MJ, Morris KT, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol. 2008;26(32):5213–9. doi: 10.1200/JCO.2008.16.3725.
    1. Erickson VS, Pearson ML, Ganz PA, et al. Arm edema in breast cancer patients. J Natl Cancer Inst. 2001;93:96–111. doi: 10.1093/jnci/93.2.96.
    1. Veronesi U, Stafyla V, Luiniand A, et al. Breast cancer: from “maximum tolerable” to “minimum effective” treatment. Front Oncol. 2012;2:1–5.
    1. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127:392–9. doi: 10.1001/archsurg.1992.01420040034005.
    1. Krag DN, Weaver DL, Alex JC, et al. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol. 1993;2:335–40. doi: 10.1016/0960-7404(93)90064-6.
    1. Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994;220:391–401. doi: 10.1097/00000658-199409000-00015.
    1. Giuliano AE, Jones RC, Brennan M, et al. Sentinel lymphadenectomy in breast cancer. Clin Oncol. 1997;15:2345–50.
    1. Veronesi U, Paganelli G, Galimberti V, et al. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet. 1997;349:1864–7. doi: 10.1016/S0140-6736(97)01004-0.
    1. Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer. 2006;106:4–16. doi: 10.1002/cncr.21568.
    1. Simmons RM, Smith SMR, Osborne MP. Methylene blue dye as an alternative to isosulfan blue dye for sentinel lymph node localization. Breast J. 2001;7:181–3. doi: 10.1046/j.1524-4741.2001.007003181.x.
    1. Simmons R, Thevarajah S, Brennan MB, et al. Methylene blue dye as an alternative to isosulfan blue dye for sentinel lymph node localization. Ann Surg Oncol. 2003;10:242–7. doi: 10.1245/ASO.2003.04.021.
    1. Varghese P, Mostafa A, Abdel-Rahman AT, et al. Methylene blue dye versus combined dye-radioactive tracer technique for sentinel lymph node localisation in early breast cancer. EJSO. 2007;33:147–52. doi: 10.1016/j.ejso.2006.09.026.
    1. Blessing WD, Stolier AJ, Teng SC, et al. A comparison of methylene blue and lymphazurin in breast cancer sentinel node mapping. Am J Surg. 2002;184:341–5. doi: 10.1016/S0002-9610(02)00948-0.
    1. 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. doi: 10.1016/j.amjsurg.2007.08.060.
    1. Mathelin C, Croce S, Brasse D, et al. Methylene blue dye, an accurate dye for sentinel lymph node identification in early breast cancer. Cancer Res. 2009;29:4119–26.
    1. Nour A. Efficacy of methylene blue dye in localization of sentinel lymph node in breast cancer patients. Breast J. 2004;10:388–91. doi: 10.1111/j.1075-122X.2004.21360.x.
    1. Golshan M, Nakhlis F. Can methylene blue only be used in sentinel lymph node biopsy for breast cancer? Breast J. 2006;12:428–30. doi: 10.1111/j.1075-122X.2006.00299.x.
    1. Thevarajah S, Huston TL, Simmons RM. A comparison of the adverse reactions associated with isosulfan blue versus methylene blue dye in sentinel lymph node biopsy for breast cancer. Am J Surg. 2005;189:236–9. doi: 10.1016/j.amjsurg.2004.06.042.
    1. Brahma B, Haryono SJ, Ramadhan, et al. Methylene blue dye as a single agent in breast cancer sentinel lymph node biopsy: initial study of cancer centre hospital (Abstract). Accepted in 19th Asian Congress of Surgery & 1st SingHealth Surgical Congress. 2013.
    1. Colditz G, Chia KS. Invasive breast carcinoma: introduction and general features. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ, editors. World Health Organization classification of tumours of the breast. Lyon: IARC Press; 2012. pp. 13–31.
    1. Colak D, Nofal A, AlBakheet A, et al. Age-specific gene expression signatures for breast tumors and cross-species conserved potential cancer progression markers in young women. PLoS ONE. 2013;8:1–15. doi: 10.1371/journal.pone.0063204.
    1. Weaver DL. Pathology evaluation of sentinel lymph nodes in breast cancer: protocol recommendations and rationale. Modern Pathol. 2010;23:S26–32. doi: 10.1038/modpathol.2010.36.
    1. Zurrida S, Veronesi U. Milestones in breast cancer treatment. Breast J. 2015;21:3–12. doi: 10.1111/tbj.12361.
    1. Giuliano AE, Gangi A. Sentinel node biopsy and improved patient care. Breast J. 2015;21:27–31. doi: 10.1111/tbj.12365.
    1. Widodo I, Dwianingsih EK, Triningsih E, et al. Clinicopathological features of Indonesian breast cancers with different molecular subtypes. Asian Pac J Cancer Prev. 2014;15:6109–13. doi: 10.7314/APJCP.2014.15.15.6109.
    1. Ahmed M, Purushotham AD, Donek M. Novel techniques for sentinel lymph node biopsy in breast cancer: a systematic review. Lancet Oncol. 2014;15:e351–62. doi: 10.1016/S1470-2045(13)70590-4.
    1. Fattahi AS, Tavassoli A, Rohbakhshfar O, et al. Can methylene blue dye be used as an alternative to patent blue dye to find the sentinel lymph node in breast cancer surgery? J Res Med Sci. 2014;19:918–22.
    1. Liu Y, Truini C, Ariyan S. A randomized study comparing the effectiveness of methylene blue dye with lymphazurin blue dye in sentinel lymph node biopsy for the treatment of cutaneous melanoma. Ann Surg Oncol. 2008;15:2412–7. doi: 10.1245/s10434-008-9953-7.
    1. Bonneau C, Bendifallah S, Reyal F, et al. Association of the number of sentinel lymph nodes harvested with survival in breast cancer. EJSO. 2015;41:52–8. doi: 10.1016/j.ejso.2014.11.004.
    1. Goyal A, Newcombe RG, Mansell RE. Clinical relevance of multiple sentinel nodes in patients with breast cancer. Br J Surg. 2005;92:438–42. doi: 10.1002/bjs.4906.
    1. Kennedy RJ, Kollias J, Gill PG, et al. Removal of two sentinel nodes accurately stages the axilla in breast cancer. Br J Surg. 2003;90:1349–53. doi: 10.1002/bjs.4298.
    1. Wong SL, Edwards MJ, Chao C, et al. Sentinel lymph node biopsy for breast cancer: impact of the number of sentinel nodes removed on the false-negative rate. J Am Coll Surg. 2001;192:684–91. doi: 10.1016/S1072-7515(01)00858-4.
    1. McCarter MD, Yeung H, Fey J, et al. The breast cancer patient with multiple sentinel nodes: when to stop? J Am Coll Surg. 2001;192:692–7. doi: 10.1016/S1072-7515(01)00847-X.
    1. Abdessalam SF, Zervos EE, Prasad M, et al. Predictors of positive axillary lymph nodes after sentinel lymph node biopsy in breast cancer. Am J Surg. 2001;182:316–20. doi: 10.1016/S0002-9610(01)00719-X.
    1. Rahusen FD, Torrenga H, van Diest PJ, et al. Predictive factors for metastatic involvement of nonsentinel nodes in patients with breast cancer. Arch Surg. 2001;136:1059–63. doi: 10.1001/archsurg.136.9.1059.
    1. Van Zee KJ, Manasseh DE, Bevilacqua JLB, et al. A nomogram for predicting the likelihood of additional nodal metastasis in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol. 2003;10:1140–51. doi: 10.1245/ASO.2003.03.015.
    1. Meretoja TJ, Leidenius MHK, Heikkila PS, et al. International multicenter tool to predict the risk of nonsentinel node metastases in breast cancer. J Natl Cancer Inst. 2012;104:1888–96. doi: 10.1093/jnci/djs455.
    1. Degnim AC, Reynolds C, Pantyaidya G, et al. Nonsentinel node metastasis in breast cancer patients: assessment of an existing and a new predictive nomogram. Am J Surg. 2005;190:543–50. doi: 10.1016/j.amjsurg.2005.06.008.
    1. Kohrt HE, Olshen RA, Bermas HR, Goodson WH, Wood DJ, Henry S, et al. New models and online calculator for predicting non-sentinel lymph node status in sentinel lymph node positive breast cancer patients. BMC Cancer. 2008;8:1–15. doi: 10.1186/1471-2407-8-66.
    1. Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305(6):569–75. doi: 10.1001/jama.2011.90.
    1. Galimberti V, Cole BF, Zurrida S, Viale G, Luini A, Veronesi P, Baratella P, Chifu C, Sargenti M, Intra M, Gentilini O. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23–01): a phase 3 randomised controlled trial. The lancet oncology. 2013;14(4):297–305.
    1. Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15:1303–10. doi: 10.1016/S1470-2045(14)70460-7.
    1. Goyal A, Dodwell D. POSNOC: a randomised trial looking at axillary treatment in women with one or two sentinel nodes with macrometastases. Clin Oncol. 2015;27:692–5. doi: 10.1016/j.clon.2015.07.005.
    1. Canavesel G, Catturich A, Vecchiol C, et al. Sentinel node biopsy compared with complete axillary dissection for staging early breast cancer with clinically negative lymph nodes: results of randomized trial. Ann Oncol. 2009;20:1001–7. doi: 10.1093/annonc/mdn746.
    1. Zavagno G, Salvo GLD, Scalco G, et al. A randomized clinical trial on sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer: results of the Sentinella/GIVOM trial. Ann Surg. 2008;247:207–13. doi: 10.1097/SLA.0b013e31812e6a73.
    1. Krag DN, Anderson SJ, Julian TB, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol. 2007;8:881–8. doi: 10.1016/S1470-2045(07)70278-4.
    1. Goyal A, Newcombe RG, Chhabra A, et al. Factors affecting failed localisation and false-negative rates of sentinel node biopsy in breast cancer—results of the ALMANAC validation phase. Breast Cancer Res Treat. 2006;99:203–8. doi: 10.1007/s10549-006-9192-1.
    1. Cox CE, Dupont E, Whitehead GF, Ebert MD, Nguyen K, Peltz ES, Peckham D, Cantor A, Reintgen DS. Age and body mass index may increase the chance of failure in sentinel lymph node biopsy for women with breast cancer. Breast J. 2002;8(2):88–91. doi: 10.1046/j.1524-4741.2002.08203.x.
    1. Kaulich DG, Keil MR, Ruecklinger E, Singer CF, Seifert M, Kubista E. Factors influencing the identification rate of the sentinel node in breast cancer. Eur J Cancer Care. 2011;20(5):627–31. doi: 10.1111/j.1365-2354.2011.01241.x.
    1. Chagpar AB, Martin RC, Scoggins CR, Carlson DJ, Laidley AL, El-Eid SE, McGlothin TQ, Noyes RD, Ley PB, Tuttle TM, McMasters KM. Factors predicting failure to identify a sentinel lymph node in breast cancer. Surgery. 2005;138(1):56–63. doi: 10.1016/j.surg.2005.03.003.
    1. 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. doi: 10.1016/S0002-9610(02)00945-5.
    1. Bezu C, Coutant C, Salengro A, et al. Anaphylactic response to blue dye during sentinel lymph node biopsy. Surg Oncol. 2011;20:e55–9. doi: 10.1016/j.suronc.2010.10.002.
    1. Trikha A, Mohan V, Kashyap L, et al. Pulmonary edema following intrauterine methylene blue injection. Acta Anesthesiol Scand. 1996;40:382–4. doi: 10.1111/j.1399-6576.1996.tb04451.x.
    1. Rzymski P, Wozniak J, Opala T, et al. Anaphylactic reaction to methylene blue dye after laparoscopic chromopertubation. Int J Gynecol Obstet. 2003;81:71–2. doi: 10.1016/S0020-7292(03)00036-5.
    1. Dewachter P, Mouton-Faivre C, Trechot P, et al. Severe anaphylactic shock with methylene blue instillation. Anesth Analg. 2005;101:149–50. doi: 10.1213/01.ANE.0000153497.60047.80.
    1. Millo T, Misra R, Girdhar S, et al. Fatal pulmonary oedema following laparoscopic chromopertubation. Natl Med J India. 2006;19:78–9.
    1. Teknos D, Ramcharan A, Oluwole SF. Pulmonary edema associated with methylene blue dye administration during sentinel lymph node biopsy. J Natl Med Assoc. 2008;100:1483–4. doi: 10.1016/S0027-9684(15)31552-2.
    1. Jangjoo A, Forghani MN, Mehrabibahar M, et al. Anaphylaxis reaction of a breast cancer patient to methylene blue during breast surgery with sentinel node mapping. Acta Oncol. 2010;46:877–8. doi: 10.3109/02841861003769964.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit