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Ramamurthy R, Kottayasamy Seenivasagam R, Shanmugam S, et al. A prospective study on sentinel lymph node biopsy in early oral cancers using methylene blue dye alone. Indian J Surg Oncol. 2014;5(3):178-83doi: 10.1007/s13193-014-0337-0.
Ramamurthy, R., Kottayasamy Seenivasagam, R., Shanmugam, S., & Palanivelu, K. (2014). A prospective study on sentinel lymph node biopsy in early oral cancers using methylene blue dye alone. Indian journal of surgical oncology, 5(3), 178-83. https://doi.org/10.1007/s13193-014-0337-0
Ramamurthy, Rajaraman, et al. "A prospective study on sentinel lymph node biopsy in early oral cancers using methylene blue dye alone." Indian journal of surgical oncology vol. 5,3 (2014): 178-83. doi: https://doi.org/10.1007/s13193-014-0337-0
Ramamurthy R, Kottayasamy Seenivasagam R, Shanmugam S, Palanivelu K. A prospective study on sentinel lymph node biopsy in early oral cancers using methylene blue dye alone. Indian J Surg Oncol. 2014 Sep;5(3):178-83. doi: 10.1007/s13193-014-0337-0. Epub 2014 Sep 04. PMID: 25419060; PMCID: PMC4235869.
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Indian J Surg Oncol. 2014 Sep;5(3):178-83. doi: 10.1007/s13193-014-0337-0. Epub 2014 Sep 04.

A prospective study on sentinel lymph node biopsy in early oral cancers using methylene blue dye alone.

Indian journal of surgical oncology

Rajaraman Ramamurthy, Rajkumar Kottayasamy Seenivasagam, Subbiah Shanmugam, Kathirvelkumaran Palanivelu

Affiliations

  1. Department of Surgical Oncology, Centre for Oncology, Government Royapettah Hospital & Kilpauk Medical College, RAMA SWATHI",, Chennai, 600028 Tamil Nadu India.
  2. Department of Surgical Oncology, Centre for Oncology, Government Royapettah Hospital & Kilpauk Medical College, Chennai, India.
  3. Department of Surgical Oncology, Coimbatore Medical College, Coimbatore, India.

PMID: 25419060 PMCID: PMC4235869 DOI: 10.1007/s13193-014-0337-0

Abstract

Sentinel Lymph Node (SLN) biopsy using a combination of radioisotopes and blue dyes have a good accuracy rate in predicting subclinical neck nodal metastases in head and neck cancers. However, the limited availability of lymphoscintigraphy facilities in India requires exploration of alternative methods of SLN detection. We evaluated the feasibility of using methylene blue dye alone in detecting SLN in cN0 early oral cancers. 32 patients with cN0 early (T1, T2) oral squamous cell cancers underwent SLN biopsy using peri tumoural methylene blue dye injection. Blue dye stained (SLN) nodes were sent for frozen section analyses. Patients who had microscopic metastases in SLN underwent modified radical neck dissections and the rest underwent selective neck dissections. Paraffin sections and IHC studies were done on all nodes. SLN was identified in 29 patients (Identification rate = 90.6 %) of which SLN was positive for metastases on frozen section in 5 patients. The sensitivity, specificity and NPV of SLN with frozen section were 80 %, 95.8 % and 95.8 % respectively. IHC with cytokeratins increased the sensitivity (100 %) and NPV (100 %) at the loss of specificity (87.5 %). Methylene blue dye alone can be successfully used for SLN identification in early oral cancers with a good accuracy and sensitivity. This method will be of use especially in resource limited countries and centres where nuclear medicine facilities are not widely available. However, it has to be validated by larger randomised multi institutional trials for wider applicability. Immunohistochemistry increases the sensitivity and negative predictive value of SLN but its applicability in real time decision making is limited.

Keywords: Oral cancer; Sentinel lymph node biopsy

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