Background
The optimum sentinel node biopsy (SNB) mapping method for breast cancer remains to
be determined. No matter which mapping agents are used, 2-site injection may be superior
to 1-site injection in limiting the false-negative rate.
Methods
We examined whether a double-mapping method with subareolar injection of blue dye
and peritumoral injection of green dye would decrease the false-negative rate of dye-only
SNB in 145 patients with early breast cancer.
Results
The identification rate for blue-dyed and/or green-dyed (including mixed color-dyed)
lymph nodes was 96.6% (140/145). Sensitivity and specificity were 95.1% (39/41) and
100% (99 of 99), respectively. Accuracy was 98.6% (138/140) with a false-negative
rate of 4.9% (2/41). There were 4 patients in whom nodes of each color were found,
but nodes of only 1 color were shown to be positive. The primary tumors of these 4
patients and of the 2 patients with false-negative results were located in the upper-outer
quadrant of the breast. When only blue-dyed or green-dyed nodes (including mixed color-dyed
nodes) were counted, the false-negative rates were 10.3% (4/39) for the subareolar
mapping technique and 10.0% (4/40) for the peritumoral mapping technique.
Conclusions
The double-mapping method based on subareolar and peritumoral injections decreases
the false-negative rate of dye-only SNB for early breast cancer. Variations in lymphatic
channels may exist in the lateral half of the breast and thus may influence identification
of positive sentinel nodes. This finding should be taken into account in cases of
multicentric breast cancer.
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Article info
Publication history
Accepted:
November 25,
2005
Received in revised form:
November 22,
2005
Received:
June 26,
2005
Identification
Copyright
© 2006 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
