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The sensitivity and specificity of methylene blue dye as a single agent in sentinel lymph node biopsy for early breast cancer

Introduction: Axillary lymph node dissection (ALND), although associated with significant morbidity, has been the standard procedure for axillary staging for breast cancer in many hospitals in Malaysia. The limited resources for radioisotope tracer and nuclear medicine service, coupled with insuffic...

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Main Authors: Ma'rof, Aimir, Amjad, Nasser Muhammad, Julaihi, Rokayah, Hardin, Mark, Mushtaq, Sohail
Format: Article
Language:English
English
Published: Malaysian Medical Association 2022
Subjects:
RD Surgery
Online Access:http://irep.iium.edu.my/106557/7/106557_The%20sensitivity%20and%20specificity%20of%20methylene%20blue%20dye.pdf
http://irep.iium.edu.my/106557/8/106557_The%20sensitivity%20and%20specificity%20of%20methylene%20blue%20dye_Scopus.pdf
http://irep.iium.edu.my/106557/
https://www.e-mjm.org/2022/v77n5/breast-cancer.pdf
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spelling my.iium.irep.1065572023-09-13T04:43:42Z http://irep.iium.edu.my/106557/ The sensitivity and specificity of methylene blue dye as a single agent in sentinel lymph node biopsy for early breast cancer Ma'rof, Aimir Amjad, Nasser Muhammad Julaihi, Rokayah Hardin, Mark Mushtaq, Sohail RD Surgery Introduction: Axillary lymph node dissection (ALND), although associated with significant morbidity, has been the standard procedure for axillary staging for breast cancer in many hospitals in Malaysia. The limited resources for radioisotope tracer and nuclear medicine service, coupled with insufficient number of trained surgeons, have been the major obstacles to perform sentinel lymph node biopsy (SLNB). Materials and Methods: This study looks into the application of 1% methylene blue dye (MBD) as a single agent for SLNB and observes the outcome and any associated complication. Thirty-four patients with early breast cancer were enrolled. Two millilitres (ml) of 1% MBD was diluted with saline to a total volume of 5 ml. After induction of general anaesthesia, 3 ml of the diluted 1% MBD is injected subdermally at the upper outer quadrant of the breast followed by 5 minutes of massage. Sentinel nodes are identified as blue nodes or lymph nodes with a blue-stained lymphatic channel and were surgically removed. All patients then underwent tumour excision, either mastectomy or breast-conserving surgery, and ALND. The sentinel nodes were categorized to positive or negative for metastases and were compared with axillary lymph nodes for diagnostic value assessment. Results: Identification rate of sentinel nodes was 91.2%. The mean number of removed sentinel nodes was 2 (SD=1) and the mean number of axillary nodes was 16 (SD=6). Sentinel node metastasis was found in 13 (41.9%) cases. There were two false-negative cases, resulting in a sensitivity of 86.7% (95%CI: 62.1-96.3). The negative predictive value of sentinel nodes to predict axillary metastasis was 88.9% (95%CI: 67.296.9). There were no complications observed. Conclusion: Although inferior to the standard dual-tracer technique, the usage of MBD as a single agent in SLNB for early breast cancer still offers favourable accuracy and identification rate. With continuous training and improved surgeons experience, performing SLNB with blue dye alone is feasible in order to reduce the risks and morbidities associated with ALND. Malaysian Medical Association 2022-09 Article PeerReviewed application/pdf en http://irep.iium.edu.my/106557/7/106557_The%20sensitivity%20and%20specificity%20of%20methylene%20blue%20dye.pdf application/pdf en http://irep.iium.edu.my/106557/8/106557_The%20sensitivity%20and%20specificity%20of%20methylene%20blue%20dye_Scopus.pdf Ma'rof, Aimir and Amjad, Nasser Muhammad and Julaihi, Rokayah and Hardin, Mark and Mushtaq, Sohail (2022) The sensitivity and specificity of methylene blue dye as a single agent in sentinel lymph node biopsy for early breast cancer. Medical Journal of Malaysia, 77 (5). pp. 552-557. ISSN 0300-5283 https://www.e-mjm.org/2022/v77n5/breast-cancer.pdf
institution Universiti Islam Antarabangsa Malaysia
building IIUM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider International Islamic University Malaysia
content_source IIUM Repository (IREP)
url_provider http://irep.iium.edu.my/
language English
English
topic RD Surgery
spellingShingle RD Surgery
Ma'rof, Aimir
Amjad, Nasser Muhammad
Julaihi, Rokayah
Hardin, Mark
Mushtaq, Sohail
The sensitivity and specificity of methylene blue dye as a single agent in sentinel lymph node biopsy for early breast cancer
description Introduction: Axillary lymph node dissection (ALND), although associated with significant morbidity, has been the standard procedure for axillary staging for breast cancer in many hospitals in Malaysia. The limited resources for radioisotope tracer and nuclear medicine service, coupled with insufficient number of trained surgeons, have been the major obstacles to perform sentinel lymph node biopsy (SLNB). Materials and Methods: This study looks into the application of 1% methylene blue dye (MBD) as a single agent for SLNB and observes the outcome and any associated complication. Thirty-four patients with early breast cancer were enrolled. Two millilitres (ml) of 1% MBD was diluted with saline to a total volume of 5 ml. After induction of general anaesthesia, 3 ml of the diluted 1% MBD is injected subdermally at the upper outer quadrant of the breast followed by 5 minutes of massage. Sentinel nodes are identified as blue nodes or lymph nodes with a blue-stained lymphatic channel and were surgically removed. All patients then underwent tumour excision, either mastectomy or breast-conserving surgery, and ALND. The sentinel nodes were categorized to positive or negative for metastases and were compared with axillary lymph nodes for diagnostic value assessment. Results: Identification rate of sentinel nodes was 91.2%. The mean number of removed sentinel nodes was 2 (SD=1) and the mean number of axillary nodes was 16 (SD=6). Sentinel node metastasis was found in 13 (41.9%) cases. There were two false-negative cases, resulting in a sensitivity of 86.7% (95%CI: 62.1-96.3). The negative predictive value of sentinel nodes to predict axillary metastasis was 88.9% (95%CI: 67.296.9). There were no complications observed. Conclusion: Although inferior to the standard dual-tracer technique, the usage of MBD as a single agent in SLNB for early breast cancer still offers favourable accuracy and identification rate. With continuous training and improved surgeons experience, performing SLNB with blue dye alone is feasible in order to reduce the risks and morbidities associated with ALND.
format Article
author Ma'rof, Aimir
Amjad, Nasser Muhammad
Julaihi, Rokayah
Hardin, Mark
Mushtaq, Sohail
author_facet Ma'rof, Aimir
Amjad, Nasser Muhammad
Julaihi, Rokayah
Hardin, Mark
Mushtaq, Sohail
author_sort Ma'rof, Aimir
title The sensitivity and specificity of methylene blue dye as a single agent in sentinel lymph node biopsy for early breast cancer
title_short The sensitivity and specificity of methylene blue dye as a single agent in sentinel lymph node biopsy for early breast cancer
title_full The sensitivity and specificity of methylene blue dye as a single agent in sentinel lymph node biopsy for early breast cancer
title_fullStr The sensitivity and specificity of methylene blue dye as a single agent in sentinel lymph node biopsy for early breast cancer
title_full_unstemmed The sensitivity and specificity of methylene blue dye as a single agent in sentinel lymph node biopsy for early breast cancer
title_sort sensitivity and specificity of methylene blue dye as a single agent in sentinel lymph node biopsy for early breast cancer
publisher Malaysian Medical Association
publishDate 2022
url http://irep.iium.edu.my/106557/7/106557_The%20sensitivity%20and%20specificity%20of%20methylene%20blue%20dye.pdf
http://irep.iium.edu.my/106557/8/106557_The%20sensitivity%20and%20specificity%20of%20methylene%20blue%20dye_Scopus.pdf
http://irep.iium.edu.my/106557/
https://www.e-mjm.org/2022/v77n5/breast-cancer.pdf
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score 13.211869

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