Methylene blue for sentinel lymph node localisation in breast cancer surgery: Experience of RIPAS Hospital

ABSTRACT

Introduction Axillary lymph node dissection (ALND) is a standard procedure in the management of breast cancer for diagnosis of axillary node metastasis and for local control. The aim of this study was to investigate the ease and the effectiveness of using methylene blue dye in the localisation of sentinel lymph node (SLN) and biopsy (SLNB) in patients undergoing surgery for breast cancer at RIPAS Hospital. Materials and Methods Twenty-five patients with confirmed fine needle aspiration cytological diagnosis of breast cancer, who were undergoing planned mastectomy and axillary node clearance, were included in the study. Four to five milliliters of methylene blue dye was injected into the peri-tumour area 20 to 30 minutes preoperatively before surgical incision was made. All SLNs were submitted for intra-operative frozen section analysis. All patients underwent mastectomy and Level II axillary clearance. Results Methylene blue dye staining and localisation of SLNs were positive in 22 (88%) patients, out of which 10 (45.45%) patients had SLN which were positive for metastasis. In three patients (12%), the dye failed to reach the axilla with one patient having micro-metastasis in the axillary lymph nodes. The mean duration to SLN harvesting was 20 min (range 15 to 25 min) after injection of the methylene blue. Complications included blue discolouration of urine (28%), post-operative fever (4%), tattooing near the scar (4%) and a small area of skin necrosis near the scar (4%). Conclusions In our setting, SLNB using methylene blue dye is also an effective method for accurately identifying SLNs in breast cancer patients and provide an accurate pathological staging without having to do a formal axillary clearance.