Objective To explore the clinical value of only using blue dye as tracer in the sentinel lymph node biopsy (SLNB) of breast cancer. Methods SLNB was performed with the guidance of the combination of blue dye and isotope in all patients enrolled. SLNB data of blue dye only, and the combination method was recorded respectively for analyses. Results Three hundred and eight patients were enrolled in this prospective study. Significant differences were found in the identification rate (IDR, 93.5% vs. 99.4%, P=0.000), the false negative rate (FNR, 14.8% vs. 3.3%, P=0.007), the accuracy rate (AR, 89.6% vs. 97.8%, P=0.006), and the negative predictive value (NPV, 74.0% vs. 93.3%, P=0.012) between the blue dye alone and the combination method. The IDR and the FNR of the two methods were not significantly associated with the patient age, tumor size and location, histopathological type, type of biopsy and breast surgery, or ER, PR, and HER-2 status (all Pgt;0.05). The FNR of blue dye alone was significantly associated with clinically suspicious turgescence of axillary lymph nodes (P=0.042) and decreased followed by the increased number of sentinel lymph nodes obtained (P=0.000). Conclusions Compared with the combination method, SLNB guided with blue dye alone had significantly poorer IDR, AR, and NPV, and higher FNR. It is recommended that the combination of dye and isotope should be adopted for the guidance of SLNB in clinical practice rather than the use of blue dye alone.
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.