Preliminary results of sentinel lymph node biopsy using blue dye for early breast cancer staging: A single-centre experience in Addis Ababa, Ethiopia

Abstract

Background: Sentinel lymph node biopsy (SLNB) is the currently accepted standard of care for axillary staging in breast cancer (BRCa). The practice of SLNB in BRCa is limited in Ethiopia and the Eastern part of Africa. This study aimed to review a single institution's experience in Ethiopia on its practice regarding SLNB using only Methylene blue dye.

Method: A retrospective review was done on all patients diagnosed with invasive BRCa and who had undergone SLNB from October 1, 2020, to October 30, 2023. SLNB was performed using only Methylene blue dye with intradermal, sub-areolar, and peri-tumoral injections. SLNs were ultra-staged by multi-level sectioning; the remaining specimens were examined by conventional methods. The success rate and outcomes of the procedure were analyzed.

Results: Twenty female BRCa patients with clinically unremarkable axillae had Sentinel lymph node mapping (SLNM). ALND was performed on all patients. The median age was 47.75 years ± 13.33. The procedure's success rate was 100%, identifying 1 to 6 SLNs and an average of 13.6 total LNs. Pathologic evaluation revealed metastases in 6 patients (30%). Three of these patients (50%) had metastasis only to SLNs. The other three patients (50%) also had metastasis to non-SLNs. There was no skip metastasis.

Conclusion: The use of blue dye alone in SLNB in our institution was successful. SLNB didn’t eliminate the need for ALND due to the scarcity of frozen section technology and radiation therapy. Although the number of patients included would not enable us to make a statistically significant conclusion requiring collecting further data, our study showed that SLNB could accurately identify LN metastasis that might have been missed with a conventional examination of ALNs. This suggests that multiple sectioning of SLNs is extremely valuable to determining axillary metastasis, directly impacting subsequent management in resource-limited setups.