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Year : 2022  |  Volume : 42  |  Issue : 2  |  Page : 64-71

The Dual Method (Dye and Ultrasound) for Axillary Mapping in Patients Receiving Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer

1 Department of General Surgery, VMMC and Safdarjung Hospital, Delhi, India
2 Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, Delhi, India

Correspondence Address:
Dr Deepak Kumar
Room No. 18, Residents' Doctors' Hostel, VMMC and Safdarjung Hospital, Delhi - 110 029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmedsci.jmedsci_416_20

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Background: Sentinel lymph node (SLN) remains one of the most important indicators of axillary lymph node status, defining the prognosis of breast cancer (BC) patients. The present study was done to map axillary SLN using dual method of intraoperative axillary ultrasound-guided (USG) and methylene blue dye, in patients receiving neoadjuvant chemotherapy (NAT) for locally advanced BC. Methods: A prospective interventional cross-sectional study was conducted on 36 core-needle biopsy-proven cases of locally advanced breast carcinoma (Stage IIb and Stage III) who received NAT. The SLNs as identified by the bluest staining node (dye method) and the node with a needle inserted in it through axillary USG method were dissected and sent for frozen section in normal saline. It was followed by complete axillary dissection and final histopathology reporting. Diagnostic test was used for calculation of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: After NAT, 26/29 patients with pre-NAT staging of N1 and 5/7 patients with pre-NAT staging of N2 showed significant downstaging of the nodal status after NAT (P < 0.001). We found that the dual method showed similar sensitivity to the dye method and the USG method (94.74%). But, the specificity, PPV, and NPV of the dual method although similar to the dye method (76.47%, 81.82%, and 92.86%, respectively) were lower than that of the USG method (82.35%, 85.71%, and 93.33%, respectively). Conclusion: In conclusion, dual method (dye and USG) is a good attempt in increasing the SLN detection but it is not a powerful test in the application of avoiding axillary lymph node dissection. The comparable sensitivity but lower specificity in determining the SLN restricts its use, and warrants future studies with contrast-enhanced USG to decrease the false negatives.

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