A PROSPECTIVE TRIAL COMPARING THE ACCURACY BETWEEN ULTRASOUND GUIDED FNAC OF AXILLARY LYMPH NODES AND SENTINEL LYMPH NODE BIOPSY USING METHYLENE BLUE FOLLOWED BY IMPRINT CYTOLOGY IN CLINICALLY NODE NEGATIVE EARLY BREAST CANCERS
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Surgical treatment of breast cancer has evolved from Halsted's radical mastectomy to breast conserving surgery. Similarly, surgical treatment of regional lymph nodes has also become less extensive. Axillary lymph node dissection (ALND) was standard of care for a long time and considered necessary for loco-regional control as well as for staging purpose. While ALND came with substantial morbidity and the majority of the ALND patients were "node negative", various studies reported no
... udies reported no effect of ALND on disease free and overall survival. In the mid-nineties the sentinel lymph node biopsy (SLNB) was introduced for staging in breast cancer patients. Conceptually, the search for sentinel lymph nodes (SLNs) in cancer patients was not new. In 1959 Gould presented his results of SLNB in patients treated for cancer of the parotid 1 followed by a report describing the retrieval of SLNs in penile cancer. Two decades later Morton popularized the use of SLNB in melanoma patients. In 1994 it was Giuliano 2 , working in the same institute as Morton, who first described the use of the procedure in breast cancer patients. Nowadays this procedure is standard of care in clinically node negative breast cancer patients. MATERIALS AND METHODS FNA done after USG of breast and axilla followed by methylene blue injection. Blue nodes identified and harvested. RESULTS Ultrasound evaluation of node done, and suspected nodes documented. Methylene blue dye injected nodes were harvested. FNAC evaluation and imprint cytology evaluation of nodes done and compared with histopathology findings. CONCLUSION In our study, using methylene blue dye gave high accuracy in evaluation of positive lymph nodes. Imprint cytology is a useful adjuvant and is less expensive method to identify positive nodes than frozen section. KEY WORDS Breast Cancer, Sentinel Node Biopsy, Methylene Blue, FNAC/ Imprint Cytology HOW TO CITE THIS ARTICLE: Sivakami M. A prospective trial comparing the accuracy between ultrasound guided FNAC of axillary lymph nodes and sentinel lymph node biopsy using methylene blue followed by imprint cytology in clinically node negative early breast cancers. BACKGROUND The incidence of breast cancer with the Urban Indian population is 34% of all cancers and has become the commonest cancer is women. W. Halstead first described radical Mastectomy for operable breast cancers. Later Patchy, Madden, and Auchinelaus used various modifications on the Radical mastectomy procedure to reduce the cosmetic and functional morbidity. Later on, Keynes, Akkins et al, Mustakallio, Hayward and other introduced various breast conservation surgical techniques. (QUART) Quadrantectomy with axillary dissection and Radiotherapy was described with results by Veronosi et al.