Comparison of the accuracy of isosulfan blue and technetium-99m lymphoscintigraphy to determine axillary lymph node metastasis in breast cancer

Abstract

Breast cancer is the most common malignant neoplasm in women, accounting for nearly 31% of all female cancers (1-3). Most patients in developed countries are diagnosed with stages I and II, of which about 65% have no axillary lymph node (ALN) metastasis (4). However, complications such as edema, seroma, injuries of veins and nerves passing through ALN, limitation of arm movements, and pain are noted (5-7). The presence and number of axillary metastatic lymph nodes are the most important prognostic factors in breast cancer (4-7). The results of clinical evaluation of the axillary region are often misleading in approximately one third of patients (7-11). It was determined in 1930 that the lymphatic drainage of the primary tumor was directed to a focal point, from where it spread to other lymph nodes. This first station of lymph node metastasis was called sentinel lymph node (SLN) (12,13). Systematic studies of breast cancer have shown that cancer spreads to one or more SLNs before spreading to other ALNs (14,15). The present study aimed to evaluate axillary sentinal lymph node metastasis for breast cancer diagnosis. The effectiveness of technetium-99 m sulfur colloid, isosulfan blue (ISB), and concomitant use of technetium-99 m sulfur colloid and ISB was compared. SUMMARYThis study aimed to compare the efficiency of isosulfan blue (ISB) and colloid methods in determining metastatic conditions of axillary lymph node in sentinel lymph node biopsy (SLNB). This prospective study was performed between April 2005 and July 2009 at Gulhane Medical Faculty, Department of General Surgery. A total of 102 female patients diagnosed with breast cancer were enrolled in the clinic of Gulhane School of Medicine. According to the diagnostic protocols of SLN, the patients were divided into three groups as follows: ISB (group I), colloid (group II), and ISB and colloid (group III). SLN was identified in 49 of 52 patients (94.2%) in the ISB group; the sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and false negativity (FN) ratio were found to be 90.9%, 75.8%, 96.1%, 55.5%, and 9.1%, respectively. On the contrary, the sentinel lymph node was identified in 38 of 38 (100%) patients in the colloid group; the sensitivity, specificity, PPV, NPV, and FN were found to be 88.2%, 100%, 100%, 91.3%, and 11.8%, respectively. In ISB and colloid groups; SLN was identified in 12 of 12 (100%) patients in the ISB and colloid groups; the sensitivity, specificity, PPV, NPV, and FN were found to be 100%, 100%, 100%, and 0%, respectively. This study showed that the combined methods applied to heterogeneous groups of patients for SLNB in breast cancer cases were minimally invasive and effective and hence could be used for evaluating nodal metastases.