Tracer agents for the detection of sentinel lymph nodes in breast cancer: Current concerns and directions for the future

Abstract

Tracer agents play a central role in axillary lymphatic mapping for sentinel node identification during breast cancer surgery. This article reviews the data concerning safety, efficacy, and availability of tracers currently in use. Alternate tracer materials are introduced, with review of the current literature.

New trends in breast cancer surgery: a therapeutic approach increasingly efficacy and respectful of the patient

“…As a result, sentinel lymph node biopsy (SLNB), a minimally invasive technique, was developed to avoid lymph node dissection in patients who have a low probability of axillary metastasis (32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48). The sentinel node is the first lymph node which receives lymph from the anatomic site of the primary breast tumour.…”

Imaging methods for the local lymphatic system of the axilla in early breast cancer in patients qualified for sentinel lymph node biopsy

“…A problem associated with the isotopic method that is rarely taken into consideration is possible temporary inaccessibility of the radiomarker. The limited number of its production sites ( 99m Tc is manufactured at 5 sites: in Belgium, Canada, France, the Netherlands and South Africa) is the cause of transient deficiencies in marker supply [ 14 ]. Such deficiencies are due to technical reasons (e.g.…”

“…The rising demand for the radiomarker is also an important factor here. In the US alone, nearly 80% of about 20 million nuclear medicine procedures carried out each year require the use of technetium isotope [ 14 ]. Further advances in the applicability of the sentinel lymph node biopsy in the treatment of other types of malignancies may significantly increase this demand.…”

Sentinel Lymph Node Biopsy in Well Differentiated Thyroid Cancer

“…Moderate and severe allergic reactions, including anaphylaxis, have been reported in up to 2% of patients receiving isosulfan blue (Kelley and Holmes, 2011). All blue dye disappears during histologic processing and does not affect histologic analysis (Roh and Koh, 2010).…”

“…All degrees of skin responses to the blue dye have also been reported. For instance, methylene blue, despite its safety record, has been associated with intense erythema, superficial ulceration, and on one occasion a necrotic lesion (Kelley & Holmes 2011). Methylene blue-induced skin necrosis results from oxidation of surrounding tissues causing breakdown of cell membranes and inflammation, as well as a local vasoconstrictive effect due to methylene blue's inhibitory effect on nitric oxide.…”