The Clinical Application Study On Methylene Blue Dyeing In Sentinel Lymph Node Biopsy Of Breast Cancer

ObjectiveTo explore factors that influence the success rate and other indicators of methylene bluedyeing sentinel lymph node biopsy (SLNB) in breast cancer, and then analyse thefeasibility of sentinel lymph node biopsy substitute of axillary lymph node dissectionfor clinical application.MethodsA retrospective analysis of126patients early breast cancer T1~2N0M0, with methyleneblue in sentinel lymph node biopsy in Chaohu Hospital Affiliated to Anhui MedicalUniversity from2009March to2012June. All lymph node biopsy samples weremarking alone, except for two cases of patients with carcinoma in situ (one case oflobular carcinoma in situ and one case of ductal carcinoma in situ), the124cases wereunderwent radical operation. In accordance with "2011China Anti-Cancer Associationfor breast cancer treatment guidelines and norms", the earlier40cases were so-calledlearning curve, because of low detection rate and high false negative rate. The former40cases and other86cases were analyzed separately in two phases, and analyze thedetection rate and false negative rate of the two phases. According to the AmericanLouisville University SLNB criteria:①Sensitivity=(SLN positive cases/axillarylymph node metastasis cases)×100%. The accuracy of SLNB (SLNB=total cases oftrue positive+negative number/SLNB number)×100%. The false negative rate(SLNB=false negative cases/axillary lymph node metastasis cases)×100%. The false positive rate (SLN=false positive cases of/ALN transfer cases)×100%. Thequalification of the outcomes of methylene blue dyeing sentinel lymph node biopsyafter the learning curve should refer to the standards of "2011China Anti-CancerAssociation for breast cancer treatment guidelines and norms".Results108cases in126patients were successful in detecting192lymph nodes about1.78perperson, and the detection rate was85.71%, including6cases of false negative with falsenegative rate was13.63%, the sensitivity is72.72%and the accuracy rate was94.44%.In the former40patients,29cases were succeed with36lymph nodes, about1.24perperson, and the detection rate was72.50%, including3cases of false negative with falsenegative rate was23.07%, and the sensitivity is46.15%and the accuracy rate was89.66%. The later86patients, there were79cases succeed with156lymph nodes havebeen found, about1.97in average and the detection rate was91.86%, including3casesof false negative, false negative rate9.67%, and the sensitivity was89.66%, theaccurate rate was93.67%. Patients’ age, body mass index (BMI), tumor size, quadrant,pathological grade, injection site have no statistical effects on detection rate of SLN(P>O.O5). The influence of injection of dye after subcutaneous injection of adrenaline inthe detection rate of SLN was statistically significant (P<O.O5). Patients’ age, bodymass index (BMI), tumor size, quadrant, pathological grade, have no statistical effectson SLN false negative rate (P>O.O5), while the the number of SLN detected havesignificant effects on SLN false negative rate (P<O.O5).Conclusion1, The methylene blue dyeing sentinel lymph node biopsy after learning curve canaccurately reflect the status of the axillary lymph nodes.2, Injection of dye after subcutaneous injection of adrenaline could influence SLNdetection rate. The number of SLN detected could affect SLN false negative rate. 3, The detection rate of sentinel lymph node biopsy of pure blue method and the falsenegative rate can reach the stantards of "2011China Anti-Cancer Association for breastcancer treatment guidelines and norms ", the biopsy success rate is higher than90%andthe false negative rate is less than10%.So the method is safe and feasible.