Sumaira Kanwal, Riaz Hussain.
Sentinel lymph node biopsy in early carcinoma breast with blue dye.
J Coll Physicians Surg Pak Jan ;15(8):515-6.

The aim of this study was to find out the sentinel lymph node involvement in early carcinoma of breast and their specificity and sensitivity. Patients included were having unifocal breast cancer (proven by FNAC or excision biopsy) of <5cm size without clinically palpable axillary lymph nodes. After anesthetizing the patient, 5 ml of 1% isosulfan blue dye was injected into the breast parenchyma surrounding the tumour. The breast was gently compressed and massaged for 5 minutes to augment the action of the lymphatic pump and promote passage of blue dye to the axilla. After this a 3-4 cm transverse incision was made just below the hair-line of the axilla. The first blue lymph node was identified and dissected out. Then mastectomy was performed and axillary lymph nodes dissection was completed. Stained and non-stained lymph nodes as well as breast tissue were sent separately for histopathology. All the 30 patients underwent mastectomy with axillary clearance. Average size of tumour was 3.6 cm (1.5-4cm). Average number of SLN mapped was 1.6 (1-3). In all the cases sentinel lymph nodes were situated at level I. SLN were having metastasis in 18 patients and in 2 patients SLN was the only nodes having metastatic deposits. SLN identification rate was 83% with 100% specificity and 94.7% sensitivity. However, false negative results were obtained in only 5.3% cases with 06 true negatives. The tumour was located in upper outer quadrant in 87.5% identified cases. Sensitivity and specificity of SLN biopsy in the present study was 89 % and 100 % respectively. The sentinel lymph node biopsy is a new, promising, minimally invasive procedure, which predicts nodal status with minimal morbidity. Axillary lymph node dissection should be reserved for patients with positive sentinel lymph node biopsies.

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