Sentinel Lymph Node Biopsy in Thyroid Cancer / 대한내분비외과학회지

The role of sentinel lymph node biopsy (SLNB) in thyroid cancer is still debatable. The primary goals of SLNB are to facilitate accurate identification of lymph node (LN) metastasis without formal lymphadenoectomy to reduce morbidity associated with LN dissection. SLN in thyroid cancer can be identified using either vital blue dye, radioactive tracer, or a combination of these methods. Here, 26 selected studies of SLNB for thyroid cancer are analyzed and reviewed. For the vital blue dye, radioisotope, and combined methods, the overall sentinel node identification rates (SNIRs) were 84.0, 98.4 and 97.9%, the overall sensitivities were 86.1, 66.7 and 90.7% and the overall false negative rates were 11.4, 16.3, and 11.4%, respectively. The combined blue dye and radioisotope method had superior SNIRs, sensitivities, and false negative rates than the single vital blue dye technique. New tracers such as carbon nanoparticles can be used in SLNB. Lateral compartment SLNB studies employing a radioisotope technique can be useful for evaluation of the occult lateral neck LN status in patients with papillary thyroid cancer (PTC), especially in cases of central neck node metastasis. Lateral SLNB may also provide useful information for medullary thyroid cancer (MTC) treatment.

Methylene Blue for Localization of Sentinel Lymph Nodes in Breast Cancer: A Comparison with Isosulfan Blue / 한국유방암학회지

PURPOSE: Isosulfan blue dye has been widely used for localizing sentinel lymph nodes (SLNs) in breast cancer patients. The use of methylene blue has recently been applied for localizing SLNs. We compared the use of each dye to investigate the effectiveness of methylene blue for the localization of SLNs. METHODS: From January to December of 2005, 326 patients underwent surgery for breast cancer at Samsung Medical Center. In 86 patients, only a blue dye was used for SLN localization. Isosulfan blue and methylene blue were randomly given. Each dye (5 mL) was given by subareolar or peritumoral injection. The injection site was gently massaged with a warm gauze for 5 min. A frozen biopsy was performed for all SLNs, and an axillary dissection was done for positive frozen biopsy cases or cases in which axillary metastasis was clinically suspected. RESULTS: Fifty-eight cases (61.1%) had been treated with isosulfan blue and 37 cases (38.9%) had been treated with methylene blue. Blue nodes were found in 96.6% of samples in the isosulfan blue group and 86.5% of samples in the methylene blue group. The mean number of SLNs was 2.10 in the isosulfan blue group and 2.27 in the methylene blue group (p>0.05). The frozen biopsy was positive for malignant cells in 16 of 56 cases in the isosulfan blue group and 4 of 32 cases in the methylene blue group. Axillary lymph node dissection was performed in 23 cases in the isosulfan blue group and 19 cases in the methylene blue group. CONCLUSION: There are no significant differences in the success rate, the mean number of SLNs found and the false negative rate between the use of isosulfan blue and methylene blue for localization of SLNs in breast cancer patients.

Study of Factors that Influence Sentinel Lymph Node Identification and Detection Rate in Cervical Cancer of Uterus / 대한산부인과학회지

OBJECTIVE: The purpose of this prospective study was to determine the feasibility of sentinel lymph node (SN) identification and to evaluate the factors that influence the sentinel node detection rate in patients with cervical cancer of the uterus. METHODS: Forty three patients underwent intracervical injection of 1% isosulfan blue dye at the time of planned radical hysterectomy and lymphadenectomy between January 2003 and July 2003. With visual detection of blue nodes, SNs were identified and separately removed. And then all patients underwent complete pelvic lymph nodes dissection and/or para-aortic lymph nodes dissection. If frozen sections of the lymph nodes were negative, radical hysterectomy was performed. Tumor characteristics, surgical findings, specific locations of SN and final pathologic results were recorded and correlated with final pathologic results. RESULTS: The mean age of patients was 49.3 years (30-78). SNs were identified in 23 of 43 (53%) patients. About 48.7% of SNs were found in the external iliac region, 31.7% in the obturator region, 17.0% in the internal iliac region and 2.4% in the common iliac region. Metastatic nodes were detected in 11 of 43 (26%) patients. Among 23 patients whose SNs were detected, 5 patients had metastatic nodes while among 20 patients whose SNs were not detected, 8 patients had metastatic nodes. No false negative SN results were obtained. Successful SN detection was more likely performed in patients with preoperative conization (P=0.0156). However, age, stage, histologic type, operation type, and neoadjuvant chemotherapy did not show any significant differences in SN detection rate. CONCLUSION: The identification of the SN with isosulfan blue dye is feasible and safe. SN detection rate was high in patients with preoperative conization. But low detection rate should be further investigated.

Effects of Isosulfan Blue and Methylene Blue on Oxygen Saturation by Pulse Oximetry in Sentinel Lymph Node Biopsy / 대한마취과학회지

BACKGROUND: In breast cancer, lymphatic mapping with blue dye has been used intraoperatively to identify the sentinel lymph nodes. Several blue dyes are known to cause spurious desaturation when measured by a pulse oximeter. This study examined the differential effects of isosulfan blue (IB) and methylene blue (MB) on the level of oxygen saturation by pulse oximetry according to the sites measured. METHODS: Forty women with breast cancer were divided into two groups according to the dyes used. The level of oxygen saturation by pulse oximetry was measured on the index finger of the unoperated arm and on the 2nd toe, respectively, before injecting the dye and, 5, 10, 15, 20, 25, 30, 60, 90, 120, and 150 minutes after. The color of the skin was evaluated on a 4 point scale. RESULTS: In the IB group, the level of oxygen saturation on the finger was significantly lower immediately after injection than the level of oxygen saturation on the toe, and remained at a significantly lower level for up to 150 minutes. In the MB group, there was no significant reduction in the level of oxygen saturation at both sites after injecting the dye. The lowest oxygen saturation in each group was 95.8 +/- 1.9%, 97.5 +/- 1.2%, 99.0 +/- 1.0%, and 99.4 +/- 1.0% in the IB-finger, IB-toe, MB-finger, and MB-toe, respectively. The color change in the skin according to the dye injection was significant in the IB group but, not in MB group. CONCLUSIONS: IB decreased the level of oxygen saturation as measured by pulse oximetry, and its effects were more pronounced on the finger than toe. MB did not decrease the level of oxygen saturation as measured by pulse oximetry at both sites. Oxygen saturation monitoring on the toe is more desirable in a sentinel lymph node biopsy using IB than the finger.

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.

Anaphylactic Reaction after an Intracervical Injection of Isosulfan Blue Dye: A case report / 대한마취과학회지

Isosulfan blue dye can be used to mark the sentinel lymph node during various surgeries. The dye was known to have minimal side effects, but recently a few cases of an anaphylactic reaction were reported in melanoma and breast surgery. We experienced an anaphylactic reaction during peritumoral injection of this dye in a patient with cervical cancer. Immediately after dye injection, the patient showed an anaphylactic reaction with cardiovascular collapse and oxygen desaturation. We resuscitated the patient and she recovered without complications.

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.