Article

Methylene blue dye - A safe and effective alternative for sentinel lymph node localization

Breast Unit, St Bartholomew's Hospital, Queen Mary University of London, United Kingdom.
The Breast Journal (Impact Factor: 1.43). 12/2007; 14(1):61-7. DOI: 10.1111/j.1524-4741.2007.00519.x
Source: PubMed

ABSTRACT Sentinel lymph node (SLN) biopsy has emerged as an effective diagnostic tool in axillary staging in breast cancer. The commonly used technique employs isosulfan blue/patent blue V combined with radioactive colloid tracer. Methylene blue (MB) is a less expensive and readily available alternative dye. The study evaluated the safety and efficacy of MB in SLN localization. A retrospective study of 329 patients with early breast cancer who had SLN localization as part of an ethically approved prospective evaluation study of SLN localization technique was carried out. Lymph node positive, tumors >2 cm on clinical and radiological evaluation, those with previous breast and axillary surgery, neo-adjuvant chemotherapy were excluded from the study. One hundred seventy three patients underwent SLN localization using 1 mL of 1% MB, and a combined MB-radio colloid tracer technique was used in the other 156 patients. Allocation to the groups was by simple randomization. Injection of the dye and radioisotope was into the subdermal plane in the sub-areolar region. Patients underwent breast conservation surgery or mastectomy with SLN directed four node axillary sampling +/- axillary clearance. The lymph node was examined by standard microscopy. There were no reported complications with the use of MB aside from temporary tattooing. The technique failed in eight patients giving an identification rate of 97.6%. Ten of the 258 (3.9%) patients had false-negative SLN, with negative predictive value of 96.1%, sensitivity of predicting further axillary disease of 73%, specificity of 87.3%, and overall accuracy of 85.7%. Reported adverse reaction to isosulfan blue/patent blue V varied from minor to severe anaphylactic reactions (1-3%) requiring vigorous resuscitation. Subdermal sub-areolar injection of MB is safe and effective readily available dye for SLN localization in axillary staging of breast cancer with no major adverse reaction.

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    • "Several kinds of blue dyes are in use for sentinel node mapping, such as Patent Blue V [9], isosulfan blue [10], and methylene blue [11]. Methylene blue is widely used in medicine [12] and has been used for sentinel node biopsy mapping since 2001 with generally favorable results [11] [13]. However, several adverse reactions have been reported, such as interference with pulse oximetry [14] and skin complications (necrosis) [15] [16] [17]. "
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    ABSTRACT: To identify the sentinel lymph node in melanoma patients, intradermal injection of a radiocolloid tracer and a blue dye are commonly used. Life-threatening side effects of isosulfan blue and Patent Blue V have been well described. However, to the extent of our knowledge, only two life-threatening events with intradermal methylene blue dye have been reported, and none has been reported in the pediatric population. We report a case of a 6-year-old white girl with spitzoid melanoma on her right forearm. She had lymphoscintigraphy under general anesthesia and was taken to the operating room intubated. Intradermal methylene blue (0.2 ml) was injected around the lesion, and after 5 minutes, wide complex bradycardia was noted and progressed to asystole within less than 1 minute. Cardiopulmonary resuscitation was started. Multiple doses of resuscitative drugs were administered, and electrical cardioversion was given twice as well. She recovered completely and transferred to the intensive care unit.
    03/2014; 2(3). DOI:10.1016/j.epsc.2014.02.009
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    • "A potential downside of this visual approach is the low detection sensitivity. Accordingly, high concentrations (10 mg ml −1 ) of blue dye are required, frequently resulting in cosmetically undesirable blue colored residues [6] that remain visible for a long period of time after the operation. Together, these limitations call for alternative methods with higher sensitivity and detection rates for optical intraoperative guidance. "
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    ABSTRACT: Specific removal of the sentinel lymph node (SLN) during breast cancer surgery presents physicians with the opportunity to detect early metastatic disease. To increase the accuracy of intraoperative SLN detection, new methods with higher sensitivity and specificity are required. We have quantitatively compared conventional preoperative lymphoscintigraphy with albumin radiocolloids ((99m)Tc-NanoColl) with optical intraoperative guidance using the near infrared dye indocyanine green (ICG) in an orthotopic mouse model for metastatic breast cancer. Furthermore, we have applied a self-assembled multimodal complex, in which ICG is non-covalently bound to the albumin radiocolloid, to attain identical dynamics of the radioactive and optical components. The SLN specificity of the multimodal complex is similar to conventional lymphoscintigraphy, while the fluorescent signal-to-noise ratio is improved by 86% compared to ICG alone. In addition, the multimodal complex permits scintigraphic validation of the fluorescent findings. The multimodal ICG-(99m)Tc-NanoColl complex can be used both for lymphoscintigraphy by preoperative single photon emission computed tomography/computed tomography and for surgical navigation by intraoperative fluorescence imaging.
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