Efficacy of Periareolar Versus Peritumoral Injection of TC99-Labelled Sulphur Colloid and Methylene Blue Dye for Detection of Sentinel Lymph Node in Patients with Early Breast Cancer: a Comparative Study

Abstract

Sentinel lymph node biopsy using dual methods of blue dye and radioactive isotope is what is practised as the standard of care at most of the centres. The combined use of radioactive colloid and blue dye injection is considered the gold standard for axillary sentinel lymph node biopsy in breast cancer with a 97% accuracy rate. The aim of this study is to determine the optimal injection site for methylene blue dye and Tc99-labelled sulphur colloid for sentinel lymph node biopsy in early breast cancer. In both periareolar and peritumoral groups of patients, overall rate of identifying sentinel lymph node (hot, blue and hot and blue nodes) with dual dye was comparable (100% and 96.36%) with p value = 0.475. Also in both groups of patients, overall rate of getting pathological positive sentinel lymph node on final histopathological report was comparable (52.73% and 45.28%) with p value = 0.561. Periareolar versus peritumoral injection of dual dye shows comparable success rates for axillary sentinel lymph node identification and can be considered rapid and reliable method. However, the periareolar route is technically simple and especially privileged in nonpalpable (T0) and upper outer quadrant lesions mainly for the prevention of the shine through phenomenon.