Sentinel lymph node biopsy mapped with methylene blue dye alone in patients with breast cancer: A systematic review and meta-analysis

Abstract

BackgroundMethylene blue dye is easy to obtain in developing countries and can be used in sentinel lymph node mapping for breast cancer. However, the accuracy of methylene blue alone for sentinel lymph node mapping in breast cancer has not been well defined. In this study, we collected data to assess the feasibility and accuracy of sentinel lymph node biopsy mapped with methylene blue alone in patients with breast cancer.MethodsWe searched the PubMed, EMBASE, and Cochrane Library databases from January 1, 1993, to March 31, 2018. Selected studies had to have a defined group of patients with breast cancer in which MBD alone was used as the mapping technique for SNB.Results18 studies were included in this study. The combined identification rate was 91% [95% confidence interval (CI): 88%-94%, I2 = 68.3%], and the false negative rate was 13% (95% CI: 9%-18%, I2 = 36.7%). The pooled sensitivity, negative predictive value, and accuracy rate were 87% (95% CI: 82%-91%, I2 = 37.5%), 91% (95% CI: 87%-93%, I2 = 32.4%) and 94% (95% CI: 92%-96%, I2 = 29%), respectively.ConclusionsThis meta-analysis found that mapping sentinel lymph node locations with methylene blue dye alone results in an acceptable identification rate but an excessive false negative rate according to the American Society of Breast Surgeons’ recommendations. Caution is warranted when using methylene blue dye alone as the mapping method for sentinel lymph node biopsy.

Intraoperative Cryosurgical Freezing Assists with Local Drug Delivery and Targeting of Tumor Fluids in VX2 Model, which Translates in Locoregional Drug Targeting of Tumor Fluids during Cryoprobe-Assisted Surgical Resection of Breast Cancer

“…Indeed, one to twelve nodes of the axillary region stained blue (Table 4) in 22 of 26 cases (84.6%). An identification rate that compares favorably with conventional BD guided lymphatic mapping 37 . Although the VX2 study did not investigate the tracer transport to lymphatic drainage, its dispersion along frozen margin and tumor-muscular interface resulted in its interstitial drainage.…”

Current concepts in the management of the axilla in early breast cancer: proposed standard of practice in Sri Lanka

“…The meta-analysis of 18 studies with 1559 patients done by Jiyu Li et al, have reported 91 percent identification rate by methylene blue alone. Hence the authors have concluded by commenting that use of methylene blue alone to localize a sentinel node did not differ substantially when compared with combination method or use of other blue dyes [17]. Unfortunately, the same meta-analysis reported a higher FNR of 13 percent which was far above the accepted false negative rate recommended by the American Society of Clinical Oncologist [15].…”

Validating a semi-quantitative method to assess the degree of methylene blue staining in sentinel lymph nodes

“…Detecting SLNs is achieved by using lymphatic tracers, most commonly injected peritumorally, that delineate lymphatic tracts to the sentinel nodes 3 . The gold standard in SLN mapping employs dual tracer techniques involving a combination of radioisotopes, blue dyes and/or fluorescence to increase reliability [4][5][6] . However, in specific countries and facilities, methylene blue dye is used alone for SLN mapping in light of its cost effectiveness, accessibility and safe outcomes 4,7,8 .…”

“…The gold standard in SLN mapping employs dual tracer techniques involving a combination of radioisotopes, blue dyes and/or fluorescence to increase reliability [4][5][6] . However, in specific countries and facilities, methylene blue dye is used alone for SLN mapping in light of its cost effectiveness, accessibility and safe outcomes 4,7,8 . Methylene blue is a non-specific blue dye with a good safety profile and has been described for use as an alternative to isosulfan blue and patent blue dye 2,4,9 .…”

“…However, in specific countries and facilities, methylene blue dye is used alone for SLN mapping in light of its cost effectiveness, accessibility and safe outcomes 4,7,8 . Methylene blue is a non-specific blue dye with a good safety profile and has been described for use as an alternative to isosulfan blue and patent blue dye 2,4,9 . Breast cancer studies that employ methylene blue dye alone suggest comparable lymphatic uptake and results to other blue dyes 2,10-14 .…”