Degnim Amy C, Oh Kevin, Cimmino Vincent M, Diehl Kathleen M, Chang Alfred E, Newman Lisa A, Sabel Michael S
Division of Surgical Oncology, University of Michigan Health System, 1500 E. Medical Center Drive, 3308 CGC/Box 0932, Ann Arbor, Michigan, 48109, USA.
Ann Surg Oncol. 2005 Sep;12(9):712-7. doi: 10.1245/ASO.2005.06.017. Epub 2005 Aug 4.
The use of isosulfan blue dye in sentinel node biopsy for breast cancer has been questioned because of its risk of allergic reaction. We hypothesized that blue dye could be safely omitted in the subgroup of patients who have evidence of successful sentinel node localization by lymphoscintigraphy.
A retrospective review of patients with breast cancer and sentinel node biopsy was conducted. Information was collected on lymphoscintigraphy results, use of blue dye, and intraoperative and pathologic findings of sentinel nodes.
We identified 475 patients with breast cancer who underwent 478 sentinel node biopsies. Both dye and isotope were given in 418 cases, of which 380 had a positive lymphoscintigram. In 5 of the 380 cases with a positive lymphoscintigram, the sentinel nodes obtained were blue but not hot, for a 1.3% marginal benefit of dye in the technical success of the procedure. Sentinel nodes positive for metastasis were found in 102 of 380 cases; in 3 cases, the only positive sentinel node was blue but not hot. Omission of the blue dye tracer would have increased the false-negative rate of the sentinel node procedure by approximately 2.5%.
Even in sentinel node biopsy cases with a positive lymphoscintigram, the use of blue dye is beneficial for both improving the technical success of the procedure and reducing the false-negative rate of the procedure. Because the marginal benefits of dye justify its routine use, strategies to minimize the toxicity of blue dye are warranted.
由于异硫蓝染料存在过敏反应风险，其在乳腺癌前哨淋巴结活检中的应用受到质疑。我们推测，对于通过淋巴闪烁造影显示前哨淋巴结定位成功的患者亚组，可以安全地省略蓝色染料。
对乳腺癌及前哨淋巴结活检患者进行回顾性研究。收集淋巴闪烁造影结果、蓝色染料使用情况以及前哨淋巴结的术中及病理检查结果等信息。
我们确定了475例接受478次前哨淋巴结活检的乳腺癌患者。418例同时使用了染料和同位素，其中380例淋巴闪烁造影呈阳性。在380例淋巴闪烁造影阳性的病例中，有5例获取的前哨淋巴结呈蓝色但不“热”，染料在该操作技术成功方面的边际获益率为1.3%。380例中有102例发现有转移的前哨淋巴结；其中3例中，唯一呈阳性的前哨淋巴结呈蓝色但不“热”。省略蓝色染料示踪剂会使前哨淋巴结检查的假阴性率增加约2.5%。
即使在淋巴闪烁造影呈阳性的前哨淋巴结活检病例中，使用蓝色染料对于提高操作技术成功率和降低检查假阴性率均有益处。由于染料的边际获益证明其常规使用的合理性，因此有必要采取策略将蓝色染料的毒性降至最低。
