Factors that affect the false negative rate of sentinel lymph node mapping with methylene blue dye alone in breast cancer

• Published in: Journal of international medical research Vol. 47; no. 10; pp. 4841 - 4853
• Main Authors: Li, Huang, Jun, Zhang, Zhi-Cheng, Ge, Xiang, Qu
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.10.2019; Sage Publications Ltd; SAGE Publishing
• Subjects: Adult; Aged; Aged, 80 and over; Axilla - pathology; Biopsy; Breast cancer; Breast Neoplasms - surgery; Clinical Research Reports; False Negative Reactions; Female; Humans; Lymphatic Metastasis - pathology; Lymphatic system; Methylene Blue - chemistry; Middle Aged; Multivariate Analysis; Risk Factors; Sentinel Lymph Node Biopsy; methylene blue; false negative rate (FNR); sentinel lymph node biopsy (SLNB); metastasis; axillary lymph node dissection; Breast neoplasm
• ISSN: 0300-0605; 1473-2300
• DOI: 10.1177/0300060519827413

Objective This study aimed to investigate the clinicopathological factors of the false negative rate (FNR) and accuracy of sentinel lymph node biopsy (SLNB) mapping with 1% methylene blue dye (MBD) alone, and to examine how to reduce the FNR in patients with breast cancer. Methods A total of 365 patients with invasive breast carcinoma who received axillary lymph node dissection after SLNB were retrospectively analyzed. SLNB was performed with 2 to 5 mL of 1% MBD. We studied the clinicopathological factors that could affect the FNR of SLNB. Results The identification rate of sentinel lymph nodes (SLNs) was 98.3% (359/365) and the FNR of SLNB was 10.4% (16/154). Multivariate analysis showed that the number of dissected SLNs and metastatic lymph nodes were independent predictive factors for the FNR of SLNB. The FNR in patients with 1, 2, 3, and ≥4 SLNs was 23.53%, 15.79%, 3.85%, and 1.79%, respectively. Conclusions SLNB mapping with MBD alone in patients with breast cancer can produce favorable identification rates. The FNR of SLNB decreases as the number of SLNs rises. Because of side effects of searching for additional SLNs and the FNR, removal of three or four SLNs may be appropriate.