Antitumor and cytotoxic potential of various extracts of Gloriosa superba L. Centaurea behen L., Elaeocarpus ganitrus Roxb and Ficus religiosa L. against human breast cancer (MDA-MB 231) cell lines

Background: Medicinal plants are rich in a wide variety of secondary metabolites such as tannins, alkaloids, phenolic compounds, flavonoids etc. which have the capability to inhibit many pathways that lead to cancer. The present study was conducted with the objectives to screen the extracts of dried roots Gloriosa superba L., dried roots of Centaurea behen L. dried fruits/beads of Elaeocarpus ganitrus Roxb., dried leaves of Ficus religiosa L. and investigate their antitumor activity on human breast cancer cell lines (MDA-MB 231). Methods: Cytotoxic activity was evaluated against non-cancerous cell lines (MCF-10A). Hexane, chloroform, methanol and water were the solvents used for extraction of phytoconstituents by Soxhlet method. Anti-proliferative potential of the plant extracts was evaluated using MTT assay. The trypan blue dye exclusion test was used to determine the number of viable cells present in a cell suspension. Results: On MDA MB-231 cell lines, 91.94% cell death was reported with G. superba aqueous extract followed by E. ganitrus methanol extract and F. religiosa hexane extract with 87.93% and 81.61% cell death respectively. Moreover, none of the extracts had shown cytotoxic effect while evaluated against normal non-cancerous cell lines (MCF- 10A). Conclusions: It is inferred from the current findings that phytoconstituents present in the plant extracts have high anticancer potential. These phytoconstituents along with some new anticancer agents present in the plant extracts reflects the high cytotoxic potential against cancer cells.

β₂-Adrenoceptor Blockade Deteriorates Systemic Anaphylaxis by Enhancing Hyperpermeability in Anesthetized Mice

PURPOSE: Patients treated with propranolol, a nonselective β-adrenoceptor antagonist, develop severe anaphylaxis, but the mechanism remains unknown. We determined effects of β₁- and β₂-adrenoceptor antagonists on the anaphylaxis-induced increase in vascular permeability in mice. METHODS: In anesthetized ovalbumin-sensitized C57BL mice, mean arterial blood pressure (MBP) was measured, and Evans blue dye extravasation and hematocrit (Hct) were assessed at 20 minutes after antigen injection. The following pretreatment groups (n=7/group) were studied: (1) sensitized control (non-pretreatment), (2) propranolol, (3) the selective β₂-adrenoceptor antagonist ICI 118,551, (4) the selective β₁-adrenoceptor antagonist atenolol, (5) adrenalectomy, (6) the selective β₂-adrenoceptor agonist terbutaline, and (7) non-sensitized groups. RESULTS: The antigen injection decreased MBP, and increased Hct and vascular permeability in the kidney, lung, mesentery, and intestine, but not in the liver or spleen. Pretreatment with ICI 118,551, propranolol and adrenalectomy, but not atenolol, reduced the survival rate and augmented the increases in Hct and vascular permeability in the kidney, intestine, and lung as compared with the sensitized control group. Pretreatment with terbutaline abolished the antigen-induced alterations. Plasma epinephrine levels were increased significantly in the sensitize control mice. CONCLUSIONS: Blockade of β₂-adrenoceptor can deteriorate systemic anaphylaxis by augmenting hyperpermeability-induced increase in plasma extravasation by inhibiting beneficial effects of epinephrine released from the adrenal glands in anesthetized mice.

Application of low concentration methylene blue dye in sentinel lymph node biopsy of breast cancer / 中国综合临床

Objective To observe the effect and the skin flap necrosis situation of low concentration methylene blue dye in sentinel lymph node biopsy of breast cancer compared with normal concentration methylene blue dye.Methods One hundred and thirty-eight cases patients with early breast cancer who were treat by sentinel lymph node biopsy surgery in Breast surgery Department of Sichuan ProvincialTumor Hospital from June 2016 to February were selected,and randomly divided into low concentration methylene blue dye group (n =69) and common concentration methylene blue dye group (n =69).Observed and recorded the sentinel lymph node detection and skin flap necrosis of relevance ratio(1％ and 0.1％ concentration methylene blue dye) concentration methylene blue dye in both two groups.Results There were no significant differences in terms of number of sentinel lymph node detection,the detection rate and false negative rate in two groups,while the rate of cutaneous necrosis in low concentration methylene blue dye group was lower (5.8％ vs.0％,P =0.025).Conclusion The effect of low concentration methylene blue dye in sentinel lymph node biopsy of breast cancer is the same as that of common concentration while the low concentration group with fewer side effects.

Impact of methylene blue staining in the retrieval of lymph nodes in resected colorectal cancer specimens.

Adequate lymph node harvest in resected colorectal cancer (CRC) specimens is important in staging and choosing appropriate therapeutic options. The yield of lymph nodes and metastatic nodes by methylene blue dye injection in 30 randomly selected resected CRC specimens was compared with an equal number of CRC specimens (control) with matched grade and stage.The mean number of lymph nodes retrieved in the study group was 22 ± 9 compared to 17 ± 8 in the control group which was statistically significant (P = 0.04).Methylene blue technique is an effective aid in increasing the yield of lymph nodes in the resected CRC specimens.

Vascular permeability and Evans blue dye: a physiological and pharmacological approach.

The acute inflammatory response consists of three main vascular effects: vasodilatation and increased blood flow, increased vascular permeability, and leukocytosis into the injured tissues. All three events are induced relatively quickly, and, for all three, the pattern of response is complex but consistent. Evans blue dye is an alkaline stain, so there is an affinity for the alkali in the acidic nucleus. The use of Evans blue dye as an in vivo marker through vascular permeability, facilitates the investigation of the effect of pathological changes in various disorders mainly, immunological disorders, inflammatory disorders, cardiovascular diseases like atherosclerosis, myocardial infarction, cancers and others. Endothelials have pathophysiological roles in pulmonary hypertension, arterial hypertension, atherosclerosis, cerebral vasospasm and inflammatory processes. The present review discussed with role of evans blue in the assessment of vascular permeability for the various pharmacological activities which are helps for the future investigations

Efficacy of calcein and Coomassie Blue dyeing of shell growing-edges and micro growth-bands: Ageing juvenile of Pinctada mazatlanica (Pterioida: Pteriidae) / Eficiencia de la tinción de bandas de crecimiento con calceina y azul de coomassie, para estimar la edad de jóvenes de Pinctada mazatlanica (Pterioida: Pteriidae)

Age validation is the first step to determine shellfish species age determination. This information is vital for different inferential models used in marine ecosystem management activities. In spite that various validation techniques are used for marking carbon calcium structures, the calcein marking technique for oysters had never been used for age validation in Pinctada mazatlanica. Thus the objectives of this study included: the evaluation of calcein to mark a shell growing-edge, and the efficacy of Coomassie Blue staining on posterior shell growth, to produce visible micro growth-bands that would enable age validation of juvenile mother-of- pearl oysters. Oysters were collected and cultivated at The Perlas del Cortez S. de R. L. MI. pearl-farming opera tion, in Pichilingue, La Paz Bay, Baja California Sur, Mexico; a total of 36 oysters (shell height 11.5-36.4mm) were injected with calcein (0.125g/L), and another 50 oysters (shell height 14.8-42.7mm) were submersed in calcein (0.4 and 0.7g/L). Shell slices of calcein-marked oysters were posteriourly stained with Coomassie Blue R-25 for micro growth-band recognition. Our results showed that Calcein marking only worked by submersion and produced a concise bright lime-green florescent band along the growing-edge with clear boundaries for both concentrations. However, marks resulted better at the lower calcein concentration (0.4g/L) with more “perfect” and “good” marks on the growing-edge (p=0.0012). Commassie Blue staining technique was successful, and allowed to conclude that one micro growth-band was laid down per day, similar to other oyster species. Mean 15-d increment of shell growth height was slightly greater at the lower calcein concentration ( =0.735mm) than at the higher one ( =0.577mm) (not significant difference, p=0.198). Calcein marking of shell growing- edges and Commassie Blue staining of posterior shell growth, as a method for age validation is recommended for shellfish shell growth-band counts. This will allow back-dating for estimation of very precise colonization dates, both spatially and temporally in future work.

La validación de la edad es el primer paso para determinar las edades de las especies de moluscos, esta información es de vital importancia para los diferentes modelos de inferencia utilizados en actividades de gestión de los ecosistemas marinos. Diversas técnicas de valida- ción se utilizan para marcar estructuras de carbonato de calcio, aunque la técnica de marcado de calceína en ostras nunca se había utilizado para la validación de la edad de P. mazatlanica. Los objetivos de este estudio fueron: evaluar la calceína como marcador interno de la concha y la eficiencia del azul de Coomassie en la tinción de la matriz proteica de la concha, para facilitar la observación y conteo de micro bandas de crecimiento que permiten validar la edad de las ostras juveniles de madre perla. Las ostras fue- ron recolectadas en la costa de la empresa Perlas del Cortez S. de RL MI., en Pichilingue en Bahía de La Paz, Baja California Sur, México. Se inyectaron 36 ostras (altura de concha 11.5-36.4mm) (0.125g/L de calceína) y otras 50 ostras (altura de la concha 14.8-42.7mm) se sumergieron (0.4 y 0.7g/L de calceína). Secciones de la concha marcadas con calceína fueron teñidos con azul de Coomassie R-25 para el reconocimiento de las micro bandas de crecimiento. El marcado con calceína fue exitoso por inmersión y produjo una banda fluorescente de color verde lima brillante con- cisa a lo largo del crecimiento interno de la concha. Sin embargo, las marcas fueron mejores a una concentración de calceína inferior (0.4g/L), con mayor cantidad de marcas “buenas” y “perfectas” (p=0.0012). La técnica de tinción con azul de Commassie también fue exitosa. Se detectó un crecimiento diario por micro banda, similar a lo encontrado en otras especies de ostras. La diferencia del crecimiento medio en relación a la altura de la concha en un lapso de 15 días, fue ligeramente mayor con una concentración de calceína inferior ( =0.735mm) que con la de mayor concentración ( =0.577mm), pero no significativamente (p=0.198). El marcado de conchas con calceína y tinción de matrices proteicas con azul de Coomassie posterior a su crecimiento, es recomendando como un método para la validación de la edad facilitando el conteo de micro bandas de crecimiento internas de la concha. Además, permitirá estimar edades con el fin de predecir fechas de colonización y ubicación de bancos naturales.

Sealing ability of two commonly used root canal sealers with and without smear layer

AIM: The aim of current research was to find out the sealing ability of two commonly used sealers in the presence and absence of smear layer at different time interval. MATERIAL AND METHODS: Total of 180 single rooted vital teeth were used. Transversal section was made with the help of digital slow speed cutting saw to divide the root and crown part. After removal of crown roots part was instrumented and prepared. The 180 teeth were randomly divided into two equal groups (n=90) 1 and 2. In group 1 the smear layer was kept intact but it was removed from group 2 with EDTA (17%). Group 1 was then divided into two sub-groups, A1, A2. Group 2 was again separated into two sub-groups, B1 and B2. Each sub-group contained of 45 samples. In sub-groups A1 and B1, AH Plus sealer, in sub-groups A2 and B2, Ketac-endo sealer and cold lateral condensation technique was used for obturation with gutta percha. All samples were kept in an incubator at 37°C for 24 hours, with help of nail polish/varnish all samples root surfaces was painted only excluding apical area after words each sub group were further divided in to three groups of 15 to represent immersion periods of 7,15 and 30 days. All samples were then kept in 5 % methylene blue dye solution at 37o c for their respective time periods. After specific time period, the roots of every group were cut longitudinally and evaluate under a stereomicroscopes to evaluate apical micro leakage in millimeter. Data was subjected to Repeated measure ANOVA with post-hoc analysis using Tukey and bonferroni tests. RESULTS: Overall analysis indicated significant reduction in sealing ability canals in with and without smear layer over different time periods (p <0.0001). CONCLUSION: Current study has concluded that AH plus sealer provides significantly better seal in the absence of smear layer than in the presence of smear layer in addition it gave better seal than Ketac-Endo sealer in the absence and presence of smear layer.

Use of Fluorescence Imaging in Combination with Patent Blue Dye versus Patent Blue Dye Alone in Sentinel Lymph Node Biopsy in Breast Cancer / 한국유방암학회지

PURPOSE: Near-infrared fluorescence imaging with indocyanine green (ICG) has the potential to improve sentinel lymph node (SLN) mapping in breast cancer. In this clinical trial, we compared the potential value of ICG combined with blue dye with that of blue dye alone for detecting SLNs. METHODS: Patients undergoing SLN biopsy (SLNB) between November 2010 and November 2013 were included. Up to December 2011, SLNs were detected by using patent blue (PB) alone, and since January 2012, by using PB in combination with ICG. The patients were divided into the following two groups: group A (ICG-PB; n=96) and group B (PB; n=73), and SLN detection parameters were compared between the groups. All patients underwent level I and II axillary dissections after SLNB. RESULTS: In group A, the SLN detection rate was 96.9% (93/96), the accuracy of detection was 98.9% (92/93), and the false-negative rate (FNR) was 3.4% (1/29). In group B, the SLN detection rate was 84.9% (62/73), the accuracy of detection was 96.8% (60/62), and the FNR was 11.1% (2/18). The ICG-PB group showed significantly superior results compared to the PB group for SLN detection (p=0.005) and a greatly improved FNR. CONCLUSION: The combined fluorescence and blue dye-based tracer technique was superior to the use of blue dye alone for identifying SLNs, and for predicting axillary lymph node status in patients with breast cancer; in addition, the combined technique had reduced false-negative results.

Trypan Blue Dye as an Adjunct to Cataract Surgery.

The current study was done to evaluate the utility and safety of Trypan Blue staining of the anterior capsule for enhancing visualization of capsulorrhexis in mature and hypermature cataracts.This study included 100 eyes of 100 patients with a unilateral mature or hypermature cataract. In all these cases 0.2ml of 0.1% Trypan blue dye was used to stain the anterior capsule in cataract surgery. In all 100 eyes the Continuous Curvilinear Capsulorrhexis (CCC) was completed. Successful cataract surgery with intraocular lens (IOL) implantation was performed in all eyes. Adverse reactions related to the dye such as raised intraocular pressure or anterior chamber inflammation was not observed in the immediate postoperative period or at the end of mean follow-up of 3 months.Trypan blue dye staining of the anterior capsule was found to be an effective and safe technique that helps in completion of Continuous Curvilinear Capsulorrhexis (CCC) in mature and hypermature cataracts.

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.

Anaphylaxis to Patent Blue V: a case series

Blue dyes such as Patent Blue V (PBV) have been used in medical procedures for decades, and in the United Kingdom they are routinely utilised in sentinel lymph node biopsy (SLNB) for staging the axilla in early breast cancer. However, it has long been recognised that such dyes are associated with anaphylaxis. It has recently been estimated in a prospective study that allergy to PBV occurs with a frequency of 0.9%. Since repeated SLNB (and therefore further exposure to PBV) is increasingly being advocated for the small proportion of patients who develop a local (in-breast) recurrence, and because anaphylaxis can be life-threatening, it is important that those individuals that are allergic to PBV are recognised on their first medical exposure. The measurement of serum mast-cell tryptase (MCT) and skin prick test (SPT) are used in the investigation of suspected anaphylaxis because positive results are supportive of type-1 mediated hypersensitivity. Here we report the clinical features, MCT results and SPT results that pertain to a series of four patients referred to our drug allergy clinic with suspected anaphylaxis following SLNB. We recommend that all patients that show clinical evidence of allergy following exposure to PBV are referred to a specialist drug allergy service for further evaluation to investigate the cause.

Validación y uso de la técnica del linfonodo centinela axilar con colorante exclusivo en pacientes con cáncer de mama / Exclusive use of blue dye to detect sentinel lymph nodes in breast cancer

Background: The use of a dye and radiocolloid to detect sentinel lymph nodes in breast cáncer increases the detection rates. However the use of either method alone does not modify the false negative rate. Therefore there is no formal contraindication for the exclusive use of dye to detect nodes. Aim: To repon a prospective analysis of the exclusive blue dye technique for sentinel node biopsy in patients with early breast cáncer Patients and methods: We analyzed the first 100 women with pathologically proven breast cáncer who met the inclusión criteria. Patent blue dye was used as colorant. In the first 25 cases sentinel node was identified using radiocolloid and blue dye an then an axillary dissection perfomed. In the next 25 women, blue dye was used exclusively for detection and an axillary dissection was perfomed. In the next 50 cases, blue dye was used and only isolated sentinel node biopsy was perfomed. Results: In 92 of the 100 women a sentinel node was successfully detected. In the first 50 women, the false negative rate of sentinel lymph node detection was 6.9 percent. No complications occurred. During follow-up, lasting three to 29 months, no axillary relapse was observed. Conclusions: Sentinel node biopsy in patients with early breast cáncer using exclusively blue dye is feasible and safe.

Laparoscopic Sentinel Lymph Nodes Biopsy in Patients with Early-Stage Cervical Cancer / 中国微创外科杂志

Objective To investigate the feasibility of sentinel lymph node(SLN) biopsy by laparoscopy in patients with early-stage cervical cancer,and its accuracy for predicting pelvic lymph nodes metastasis.Methods A total of 26 patients with early-stage cervical cancer were enrolled in this study.Laparoscopic bilateral pelvic lymphadenectomy and radical hysterectomy were carried out in all the cases.During the operation,4 ml of methylene blue dye(1%) were injected into the cervix at 4 sites around the tumor.Both the blue-dyed lymph nodes and the other resected tissues were removed for pathological examination by HE staining.The blue-dyed lymph node was considered as SLNs,and the pathological results of all the removed pelvic lymph nodes were set as a gold standard,based on which the accuracy and false-negative rate of SLN biopsy,as well as the distribution of the SLN were determined.Results Of the 26 cases,a total of 51 SLNs were found in 23 patients(88.5%),among which 6 patients had 1 SLN,9 had 2,6 had 3,1 had 4,and 1 had 5;65.2%(15) of the patients had bilateral SLN.Five of the 26 patients(19.2%) showed pelvic lymph nodes metastases.In the 23 patients diagnosed as having SLN,3 had metastases in the SLNs(totally 6 SLNs were involved,2 of the 3 cases had the metastasis both in the SLN and pelvic lymph nodes,the other had the metastasis only in the SLN).In one patient,the biopsy was negative in SLN,but positive in the pelvic lymph nodes.In this series,the accuracy,sensitivity,specificity and negative predictive value of SLN biopsy were 95.7%(22/23),75%(3/4),100%(19/19),and 95%(19/20),respectively.There was a correlation between SLNs and pelvic lymph nodes status(?=0.832).Conclusions It is feasible to accurately detect SLNs using laparoscopic SLNs biopsy in patients with early-stage cervical cancer.The method is capable of predicting the disease,as well as the metastasis of local lymph nodes.

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.

Combined Peritumoral and Subareolar Injection of Blue Dye Improves Sentinel Lymph Node Localization Rates

PURPOSE: The sentinel lymph node (SLN) biopsy was recently introduced into the treatment of early breast cancer. However, there have been varying degrees of success in identifying the SLNs. Lymphatic mapping in breast cancer performed solely by intraparenchymal injection of blue dye remains an accepted method of identifying SLNs, largely because of its simplicity. This article describes the technical aspect and improved results of combined peritumoral and subareolar injection of isosulfan blue dye. METHODS: From Jan. 2000 to Jul. 2000, 55 patients with breast cancer (size<5 cm and clinically negative axillary nodes) were enrolled for SLN biopsy by peritumoral and subareolar injection of 1% isosulfan blue dye. And all patients underwent a complete axillary dissection. RESULTS: The identification rate of SLN was 96.4% (in 53 of 55 patients). Of these 53 patients, 11 patients (20.8%) had positive SLNs and 42 patients had negative SLNs. In 42 patients with negative SLNs, one patients was found to have disease on complete dissection, for a false-negative rate of 8.3% (1/12). CONCLUSION: Compared with other series of blue dye- directed lymphatic mapping, the present study of peritumoral plus subareolar plexus dye-only injection demonstrates a high SLNs localization rate and rapid learning curve. On the basis of these results, it is expected that subareolar lymphatic plexus is the central route to sentinel lymph nodes and the optimal way to perform dye-only lymphatic mapping of the breast.

Dextrose Swallowing Test to Detect Aspiration for Patient with Tracheostomy

OBJECTIVE: To evaluate the usefulness of 10% dextrose swallowing test (DST) to detect aspiration for patient with tracheostomy in comparison with modified blue dye test (MBDT). METHOD: Fifteen brain injured patients with tracheostomy were tested by DST and MBDT. The newly developed DST consists of 3 steps. In the first step, 5 cc 10% dextrose solution is fed 3 times by spoon. In the second step, tracheal secretion is sampled by suction catheter just before swallowing, and 30 seconds, 90 seconds after swallowing. In the third step, tracheal secretion is smeared to glucose oxidase test strip to detect aspiration with color change from pink to purple. MBDT with 0.01 % methylene blue solution was also performed in the same order. The tracheal secretion was smeared to the white paper to see the color change to blue. Videofluoroscopic swallowing study (VFSS) was performed for 9 out of 15 patients. RESULTS: Fourteen out of 15 patients showed the same outcome in DST and MBDT (kappa=0.815). Seven out of 9 patients showed the same outcome in DST and VFSS (kappa=0.571). Eight out of 9 patients showed the same outcome in MBDT and VFSS (kappa=0.780). CONCLUSION: The DST is a reliable method to detect aspiration for patient with tracheostomy.