Department of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.
World J Surg. 2011 Jun;35(6):1254-9. doi: 10.1007/s00268-011-1094-7.
Most centers use lymphoscintiscan for identification of a sentinel lymph node (SLN) and frozen section for its evaluation. The aim of the present study was to assess the accuracy of peritumoral methylene blue dye injection for SLN identification and the technique of touch imprint cytology (TIC) for its evaluation.
One hundred and eight fine needle aspiration cytology (FNAC)-proven breast cancer patients with clinically N0 axilla were recruited for the study. Prior to the induction of anesthesia, 5 ml of 1% methylene blue was injected in the peritumoral region to stain the sentinel node, following which conventional modified radical mastectomy was performed. Touch imprint cytology was obtained from the cut surface of the SLN, and then the SLN along with all nonsentinel nodes were sent for histopathology.
Intraoperative identification of a blue node was possible in 102 of 108 patients (94%). Touch imprint cytology had a sensitivity of 88%, specificity of 98%, and overall diagnostic accuracy of 94% for diagnosing metastasis in the SLN. The false positive rate for malignancy of TIC versus histology was 2.5% and the false negative rate 7.8%.
Blue dye lymphatic mapping by peritumoral injection of methylene blue was found to be accurate and cost effective for SLN identification. It avoids the expenses of lymphoscintiscanning, which requires special infrastructure and expertise with a significant learning curve. The identified SLN can, with reasonable accuracy, be assessed for metastasis by TIC. The frequently used method of frozen section requires a cryostat and a pathologist trained in the technique. Additionally scanty SLN tissue can be wasted in the cryostat and freezing artifacts can be introduced in the imprint, both of which are avoided by TIC.
大多数中心使用淋巴闪烁扫描来识别前哨淋巴结 (SLN)，并使用冷冻切片来评估其结果。本研究旨在评估肿瘤周围亚甲蓝染料注射用于识别 SLN 的准确性，以及触印细胞学 (TIC) 技术用于评估 SLN 的准确性。
本研究招募了 108 例经细针穿刺细胞学 (FNAC) 证实的乳腺癌临床 N0 腋窝患者。在诱导麻醉前，在肿瘤周围区域注射 5ml 1%亚甲蓝染色前哨淋巴结，然后行常规改良根治性乳房切除术。从 SLN 的切面获取触印细胞学标本，然后将 SLN 连同所有非前哨淋巴结一起送检行组织病理学检查。
108 例患者中有 102 例 (94%) 可在术中识别蓝色淋巴结。触印细胞学对 SLN 转移的诊断敏感性为 88%，特异性为 98%，总诊断准确性为 94%。TIC 与组织学相比恶性肿瘤的假阳性率为 2.5%，假阴性率为 7.8%。
肿瘤周围注射亚甲蓝进行蓝色染料淋巴定位被发现对 SLN 识别是准确且具有成本效益的。它避免了淋巴闪烁扫描的费用，淋巴闪烁扫描需要特殊的基础设施和专业知识，并且具有显著的学习曲线。通过 TIC，可以以合理的准确性评估所识别的 SLN 是否发生转移。常用的冷冻切片方法需要一台冷冻切片机和一位接受过该技术培训的病理学家。此外，冷冻切片机可能会浪费少量的 SLN 组织，并且在印迹中可能会引入冷冻伪影，这些都可以通过 TIC 避免。
