Clinical Application of Combination of Radiolabeled Colloid and Blue Dye in Sentinel Lymph Node Biopsy for Early-Stage Breast Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

TIAN Chunxiang ¹ , CHEN Jie ¹ , WEI Bing ² , OU Xiaohong ³ , ZHANG Zhang ² , ZHOU Lina ³ , LONG Quanyi ¹ , ZENG Helin ¹ , WANG Qiang ¹ , FAN Xuejiao ¹ , WANG Rong ¹ , LU Qing. ¹

1. Department of Thyroid &;
Breast Surgery， West China Hospital， Sichuan University， Chengdu 610041， Sichuan Province， China;;
2. Department of Pathology， West China Hospital， Sichuan University， Chengdu 610041， Sichuan Province， China;;
3. Department of Nuclear Medicine， West China Hospital， Sichuan University， Chengdu 610041， Sichuan Province， China;

Corresponding author：

Keywords：

Breast cancer; Sentinel lymph node biopsy; Radiolabeled colloid; Blue dye

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Objective 　To explore the clinical application of combination of radiolabeled colloid （99Tcm-sulphur colloid） and blue dye in sentinel lymph node biopsy （SLNB） for early-stage breast cancer.
Methods 　SLNB was performed with the guidance of blue dye, radiolabeled colloid, and the combination method in all patients enrolled, and clinical and pathological data were recorded respectively for analysis.
Results 　Two hundred and one patients were enrolled in this study and the SLN were successfully detected in 200 cases. The identification rate of radiolabeled colloid method and combination method was 99.5% （200/201） and 99.5% （198/199） respectively, which significantly higher than blue dye method （85.4%, P＜0.001）. There were no differences of accuracy rate 〔95.3% （162/170） vs. 94.5% （189/200） vs. 98.0% （194/198）, P=0.185〕 and false negative rate 〔11.3% （8/71） vs. 13.9% （11/79） vs. 5.1% （4/79）, P=0.165） between blue dye method, radiolabeled colloid method, and combination method. The combination method could detect more SLN than radiolabeled colloid method or blue dye method only （P＜0.001）. Compared to combination method, there were 12 and 7 patients miss diagnosed in blue dye method and radiolabeled colloid method, and the miss diagnosed rate was 16.0% （12/75） and 9.3% （7/75）, respectively.
Conclusions 　Compared to radiolabeled colloid and blue dye method, combination method has higher identification rate, and could identify more SLNs. It is recommended that the combination of radiolabeled colloid and blue dye should be adapted for procedure of SLNB in clinical practice.

Citation： TIAN Chunxiang,CHEN Jie,WEI Bing,OU Xiaohong,ZHANG Zhang,ZHOU Lina,LONG Quanyi,ZENG Helin,WANG Qiang,FAN Xuejiao,WANG Rong,LU Qing.. Clinical Application of Combination of Radiolabeled Colloid and Blue Dye in Sentinel Lymph Node Biopsy for Early-Stage Breast Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(9): 934-938. doi: Copy

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1. Benson JR， della Rovere GQ. Axilla Management Consensus Group. Management of the axilla in women with breast cancer[J]. Lancet Oncol， 2007， 8(4)：331-348.
2. de Boer M， van Dijck JA， Bult P， et al. Breast cancer prognosisand occult lymph node metastases， isolated tumor cells， and micrometastases[J]. J Natl Cancer Inst， 2010， 102(6)：410-425.
3. Giuliano AE. Mapping a pathway for axillary staging：a personal perspective on the current status of sentinel lymph node dissection for breast cancer[J]. Arch Surg， 1999， 134(2)：195-199.
4. Posther KE， Wilke LG， Giuliano AE. Sentinel lymph node dissection and the current status of american trials on breast lymphatic mapping[J]. Semin Oncol， 2004， 31(3)：426-436.
5. Lyman GH， Giuliano AE， Somerfield MR， et al. Americansociety of clinical oncology guideline recommendations for sentinellymph node biopsy in early-stage breast cancer[J]. J ClinOncol， 2005， 23(30)：7703-7720.
6. Goldhirsch A， Ingle JN， Gelber RD， et al. Thresholds for therapies：highlights of the St. Gallen international expert consensus on the primary therapy of early breast cancer 2009[J]. Ann Oncol， 2009， 20(8)：1319-1329.
7. Krag DN， Anderson SJ， Julian TB， et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer：overall survival findings from the NSABP B-32 randomised phase 3 trial[J]. Lancet Oncol， 2010， 11(10)：927-933.
8. American Joint Committee on Cancer. AJCC Cancer Staging Handbook[M]. 7th ed. Chicago， IL：Springer， 2010：347-376.
9. Calhoun KE， Hansen NM， Turner RR， et al. Nonsentinel node metastases in breast cancer patients with isolated tumor cells in the sentinel node：implications for completion axillary node dissection[J]. Am J Surg， 2005， 190(4)：588-591.
10. Cserni G， Bianchi S， Vezzosi V， et al. Sentinel lymph node biopsy in staging small (up to 15 mm) breast carcinomas. Results from a European multi-institutional study[J]. Pathol Oncol Res， 2007， 13(1)：5-14.
11. Krag DN， Weaver DL， Alex JC， et al. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe[J]. Surg Oncol， 1993， 2(6)：335-339.
12. Giuliano AE， Kirgan DM， Guenther JM， et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer[J]. Ann Surg， 1994， 220(3)：391-401.
13. Fleissig A， Fallowfield LJ， Langridge CI， et al. Post-operative arm morbidity and quality of life. Results of the ALMANAC randomised trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer[J]. Breast Cancer Res Treat， 2006， 95(3)：279-293.
14. Ashikaga T， Krag DN， Land SR， et al. Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection[J]. Surg Oncol， 2010， 102(2)：111-118.
15. Mansel RE， Fallowfield L， Kissin M， et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer：The ALMANAC trial[J]. J Natl Cancer Inst， 2006， 98(9)：599-609.
16. Veronesi U， Paganelli G， Viale G， et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer[J]. N Engl J Med， 2003， 349(6)：546-553.
17. 左文述，于志勇，郑刚. 乳腺癌前哨淋巴结活检研究的现状与展望[J]. 外科理论与实践， 2011， 16(1)：14-18.
18. 郑刚，杨靖，左文述，等. 中国乳腺癌前哨淋巴结活检验证阶段研究结果的系统评价[J]. 中华医学杂志， 2011， 91(6)：361-365.
19. 贺青卿，姜军，杨新华，等. 乳腺癌淋巴引流途径的临床研究[J]. 中华乳腺病杂志(电子版)， 2008， 2(2)：140-148.
20. 唐平，魏兵，杨雯娟，等. 乳腺癌前哨淋巴结的病理检测[J]. 中国普外基础与临床杂志， 2010， 17(12)：1225-1230.
21. Silverstein MJ， Lagios MD， Recht A， et al. Image-detected breast cancer：state of the art diagnosis and treatment[J]. J Am Coll Surg， 2005， 201(4)：586-597.
22. Turner RR， Ollila DW， Stern S， et al. Optimal histopathologic examination of the sentinel lymph node for breast carcinoma staging[J]. Am J Surg Pathol， 1999， 23(3)：263-267.
23. Brogi E， Torres-Matundan E， Tan LK， et al. The results of frozensection， touch preparation， and cytological smear are comparable for intraoperative examination of sentinel lymph nodes：a study in 133 breast cancer patients[J]. Ann Surg Oncol， 2005， 12(2)：173-180.
24. Salem AA， Douglas-Jones AG， Sweetland HM， et al. Intraoperative evaluation of axillary sentinel lymph nodes using touchimprint cytology and immunohistochemistry. PartⅡ. Results[J]. Eur J Surg Oncol， 2006， 32(5)：484-487.
25. 孙慎友，沈坤炜. 早期乳腺癌初始治疗的争议领域——2011 St. Gallen专家共识[J]. 外科理论与实践， 2011， 16(6)：603-604.
26. 王永胜. 乳腺癌前哨淋巴结活检：共识与展望[J]. 中国普外基础与临床杂志， 2009， 16(7)：505-509.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Application of Combination of Radiolabeled Colloid and Blue Dye in Sentinel Lymph Node Biopsy for Early-Stage Breast Cancer

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