| 1. Clinical Study of Sentinel Lymph Node Biopsy Using 1% Isosulfan Blue in Breast Cancer Patients Objectives To study sentinel lymph node biopsy (SLNB) in breast cancer patients by using 1%isosulfan blue and its feasiblity, accuracy and clinical value. Methods After induction of general anesthesia,5ml 1%isosulfan blue was injected around the tumour or periareolar into subdermal and breast parenchyma at random. A standard intervel of approximately 5 minutes later,a transverse incision was made just below the hair-bearing region of the axilla. Tedious dissection was performed until one or two lymphtic tracts or blue-stained node,ie sentinel lymph node (SLN), was identified. Intraoperative frozen-section technique and imprint cytology of SLN were adopted. All patients undergoing modified radical mastectomy or radical mastectomy with axillary lymph nodes dissection (ALND) were completed. All nodes in the ALND specimen were processed for histologic examination using hematoxylin and eosin staining. Complications related to ALND were carefully observed.Results In 99 cases studied, SLNs were identified in 89 patients,of which 83 cases were located at central and anterior node group (93.26%), with a detection rate of 89.89%.The sensitivity of SLNB in this study was 76.92%,accuracy 84.85%, false negative 12.82%, and false positive 0. The sensitivity of SLNB in 90 cases without palpable enlarged axillary lymph node was 86.67%, accuracy 88.89%, false negative 10%, false positive also 0. The detection rate of peritumoral and periareolar injection for location of SLN was 91.84% and 88% respectively (P > 0.05). Of 99 consecutive breast cancer patients, the sensitivity of the first 48 cases was 62.5%, accuracy 77.08%, and false negative 25%; but the sensitivity of the remained 51 cases was 86.96%, accuracy 92.16%, and false negative 4.35%.Palpable enlarged axillary lymph node was related to a high rate of false negative(P < 0.05). Complications followed by ALND were pain in 81 patients (82.65%), seroma 69(70.41%), arm dysfunction 14(14.29%) and lymphedema 6(6.12%). No significant side-effect of isosulfan was found.Conclusions There are some complications related to ALND.Some factors such as palpable enlarged axillary lymph node before operation and lack of experience may lead to false negative easily. SLNB using 1%isosulfan blue possesses the characterics of low expenses, safety ,and being easy to handle.After well-training, this method will begreatly improved in both the accuracy and the sensitivity and may be widely used in the selective ALND.2.Clinical and Experimental Study for the Choice of Vital Dyes and the Time during Sentinel Lymph Node Biopsy in Breast CarcinomaObjectives In order to provide choice about vital dye and the time of sentinel lymph node biopsy(SLNB) in breast cancer patients conveniently and reliably, animal model about lymphatic drainage from breast was set up. 1% isosulfan blue, which was widely applied abroad, and 1%methylene blue,being often used in our country, were chosen while the procedure of SLNB clinically was imitated. In clinical study of breast cancer patients, lymphatic tract and nodes blue-stained by 1% isosulfan blue were observed dynamically.Methods After anesthesia, 12 female adult rabbits were used to observe the lymphatic drainage from the second mammal to axillary lymph nodes stained by 1% isosulfan blue, methylene blue and isosulfan blue plus 1% methylene blue. Each mammal was injected vital blue 0.1 ml.On the other hand, 12 breast cancer patients were consecutively evaluated after SLNB. After the location of axillary lymph nodes, mainly anterior and central node group.was exposed, 1%isosulfan blue about 5 ml was injected around areola of nipple or tumor into subdermal and parenchyma at random.Blue-stained lymphtic tract and node were carefully observed.Results The average time from vital dye injection of the second mamma in rabits to nodes being stained was 8.75, 13.13 and 9.25 seconds by using isosulfan, methylene and isosulfan plus meth...
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