Endoscopic Sentinel Node Biopsy / 한국유방암학회지

PURPOSE: Sentinel node biopsy has emerged recently as an alternative to routine axillary node dissection in predicting axillary nodal metastasis. However there have been some controversies in clinical application because of its various identification rates and false negative rates. We present the usefulness of dye-guided endoscopic sentinel node biopsy. METHODS: Between October 2002 and June 2003, 30 breast cancer patients with clinically node negative results underwent endoscopic blue dye-guided sentinel node biopsy from the Department of Surgery at Kangbuk Samsung Hospital. The technique involved the injection of 5 ml of 1% isosulfan blue into subareolar plexus. The Visiport docked with Telescope was inserted through a low transverse axillary incison lateral to pectoralis major. During the dissection, we identified sentinel nodes by following blue-stained lymphatics directly into blue (or nonblue) lymph nodes. The identification rate and false negative rate was evaluated. RESULTS: The mean number of sentinel nodes was 2.2. The identification rate of th sentinel node was 93.3% (28/30). Among 22 patients with negative sentinel nodes on frozen section, 10 patients underwent axillary node dissection and the results were negative in all cases, indicating false negative rate of 0% (0/10). The overall accuracy, sensitivity and specificity were 100%. CONCLUSION: The endoscopic technique of sentinel node biopsy can minimize the operative bleeding by handling the knife of Visiport pallelel to exposed vessels under endoscopic monitor analysis and and keep better operative visual field and less invasiveness. With the bright illumination of the endoscopic light, blue-stained sentinel lymphatics could be identified more easily. Our technique of dye-guided endoscopic sentinel node biopsy demonstrates a high sentinel node identification rate and absent false negative rate, promising it could be an alternative to the classic sentinel node biopsy.

Decrease in Pulse Oximeter Readings Following Injection of Isosulfan Blue Dye / 한국유방암학회지

PURPOSE: A sentinel lymph node mapping with blue dye has been well accepted as a common procedure in breast cancer surgery. However, it is well known that blue dye absorbed into the circulation may interfere pulse oximetery reading. The aim of this study was to evaluate the change of pulse oximetery reading by isosulfan blue dye injection during sentinel lymph node mapping. METHODS: Thirteen breast cancer patients with normal preoperative cardiopulmonary functions were studied. Four ml of isosulfan blue dye was injected subdermally when the patient became stable after induction of general anesthesia. The pulse oximetery was monitored continuously. Multiple arterial blood gas analyses (ABGA) were performed before dye injection and 10, 30, 40 minutes after dye injection. The results of oxygen saturturation by oximetery (SpO2) and the results of arterial oxygen tension (SaO2) and arterial oxygen saturation (SaO2) by ABGA were compared. RESULTS: The value of both SaO2 and PaO2 measured by ABGA has not been altered by isosulfan dye injection. However SpO2 decreased by isosulfan dye injection. SpO2 decrease started 8.2+/-1.5 (2~0) minutes after dye injection and returned to preinjection level by 85.7+/-5.6 (60~126) minutes after injection. The lowest vaule of SpO2 was 95.6+/-1.2% (93~97). Mean duration of SpO2 decrease was 77.5+/-6.2 (40~117) minutes. The duration of SpO2 decrease was longer in the aged patients, but it was not statistically significant (p=0.3). There was no siginificant difference in duration of SpO2 decrease according to injection site, operation method, and body mass index (BMI). CONCLUSION: .Isosulfan dye injection using for sentinel lymph node mapping causes no change in true ABGA results but causes a mild reversible decrease in SpO2, It is important to look for other causes when SpO2 decrease is significant and persistent.

A Case of Anaphylactic Reactions to Isosulfan Blue Dye in A Cervical Cancer Patient / 대한산부인과학회잡지

The sentinel lymph node is defined as the first node of a regional lymphatic basin that receives the lymphatic drainage from a tumor, thus representing an elective site of lymph node metastasis. According to the sentinel lymph node hypothesis, histologically negative sentinel lymph nodes can guarantee the histological negativity of the remaining regional lymph nodes. These assumptions suggest that the sentinel node can be a suitable marker of regional lymph node status. Thus sentinel node biopsy may be a reasonable alternative to unnecessary pelvic lymph nodes dissection and a suitable method for limited control of early stage cervical cancer. To improve the sentinel node detection in surgical procedures, we investigated lymphatic mapping of sentinel lymph nodes with isosulfan blue dye (lymphazur 1%) and technetium-99m colloid albumin. We have made it a rule to inject 5 ml of isosulfan blue dye in the peritumoral area of cervix. It is reported that isosulfan blue dye has been safe and easily used in the detection of sentinel lymph node in melanoma, breast cancer and vulvar cancer. We experienced a case of anaphylactic reactions to isosulfan blue dye in cervical cancer patient, so we report it with a brief review of literature.

Sentinel Lymph Node Biopsy Using Technetium- 99m Antimony Sulfide Colloid and Isosulfan Blue Dye in Breast Cancer Patients / 한국유방암학회지

PURPOSE: Sentinel lymph node (SLN) biopsy is a useful method for assessing axillary nodal status and selecting axillary dissection in breast cancer patients. The goals of our study were to evaluate the detection rate of SLN and determine the accuracy of SLN biopsy in predicting axillary nodal status using technetium radiolabeled sulfur colloid and isosulfan blue dye. METHODS: Between January and August 2001, 55 breast cancer patients with clinically node negative results underwent SLN biopsy from the Department of Surgery at Ajou University Hospital. Both technetium radiolabeled sulfur colloid and isosulfan blue dye were used to guide SLN biopsy. SLN biopsy was always followed by a complete axillary dissection. The histopathology of SLNs determined from frozen sectioning and serial sectioning was compared with that of the nonsentinel nodes evaluated with routine Hematoxylin and Eosin stain. RESULTS: The overall SLN detection rate was 85.4% (47 of 55 patients). The staging accuracy of SLN biopsy was 97.9% (46 of 47 patients), the sensitivity 92.3% (12/13), the false negative rate 7.7% (1/13), and the negative predictive value 97.1% (34 of 35). CONCLUSION: Our study was a pilot study for SLN biopsy. SLN biopsy was more effective when a combination of technetium radiolabeled sulfur colloid and isosulfan blue dye were used. The results of our study support the hypothesis that SLN biopsy is an accurate predictor of axillary nodal status. SLN biopsy may be applicable to early breast cancer patients and thereby allow the omission of routine axillary dissection in selected cases.

Sentinel Lymph Node Biopsy Using Technetium- 99m Antimony Sulfide Colloid and Isosulfan Blue Dye in Breast Cancer Patients

PURPOSE: Sentinel lymph node (SLN) biopsy is a useful method for assessing axillary nodal status and selecting axillary dissection in breast cancer patients. The goals of our study were to evaluate the detection rate of SLN and determine the accuracy of SLN biopsy in predicting axillary nodal status using technetium radiolabeled sulfur colloid and isosulfan blue dye. METHODS: Between January and August 2001, 55 breast cancer patients with clinically node negative results underwent SLN biopsy from the Department of Surgery at Ajou University Hospital. Both technetium radiolabeled sulfur colloid and isosulfan blue dye were used to guide SLN biopsy. SLN biopsy was always followed by a complete axillary dissection. The histopathology of SLNs determined from frozen sectioning and serial sectioning was compared with that of the nonsentinel nodes evaluated with routine Hematoxylin and Eosin stain. RESULTS: The overall SLN detection rate was 85.4% (47 of 55 patients). The staging accuracy of SLN biopsy was 97.9% (46 of 47 patients), the sensitivity 92.3% (12/13), the false negative rate 7.7% (1/13), and the negative predictive value 97.1% (34 of 35). CONCLUSION: Our study was a pilot study for SLN biopsy. SLN biopsy was more effective when a combination of technetium radiolabeled sulfur colloid and isosulfan blue dye were used. The results of our study support the hypothesis that SLN biopsy is an accurate predictor of axillary nodal status. SLN biopsy may be applicable to early breast cancer patients and thereby allow the omission of routine axillary dissection in selected cases.