Combination technique is superior to dye alone in identification of the sentinel node in breast cancer patients

Background: The purpose of the present study was to evaluate whether the co mbination of dye and radioisotope would improve the detection rate of senti nel nodes (SN) and the diagnostic accuracy of axillary lymph node status ov er dye alone in patients with breast cancer. Methods: Sentinel node biopsy (SNB) was performed in stages I or IT breast cancer patients with clinically negative nodes using dye alone (indocyanine green) or a combination of dye and radioisotope (99mTc-radiolabelled tin c olloid). Results: SNB guided by dye alone was performed in 93 patients and SNB guide d by a combination of dye and radioisotope was performed in 138 patients. T he detection rate of SN was significantly (P = 0.006) higher in the combina tion group (94.9%) than in the dye alone group (83.9%). The sensitivity, sp ecificity, and overall accuracy of SNB in the diagnosis of axillary lymph n ode status were 100, 100, and 100%, respectively, for the combination group , and 81.0, 100, and 94.9%, respectively, for the dye alone group. There we re no false negatives in the combination group, but four false negatives (1 9.0%) in the dye alone group. The combination method was significantly supe rior to the dye alone method for sensitivity (P = 0.011) and accuracy (P = 0.018). Conclusions: The addition of a radioisotope to the dye in NB increases the detection rate of SNs in breast cancer patients, and SNs detected by the co mbination method predict the axillary lymph node status with greater accura cy than those detected by the dye alone method. (C) 2001 Wiley-Liss, Inc.