Sentinel Lymph Node Biopsy in Early Breast Cancer Using Isosulfan Blue Dye alone in Resource-Limited Centers- Our Experience

Author(s): Huma Majeed Khan, Bushra Rehman, Rabia Ikram, Anam Waseem


To evaluate the efficacy of Sentinel Lymph Node Biopsy in early Breast Cancer using Isosulfan Blue dye alone in areas where nuclear medicine facilities are not available.

Material and Methods

Data was retrospectively reviewed from July 2019 to December 2020. Only those patients were included who had clinically and radiologically negative axilla without distant metastasis. Those who needed down staging, SLNB was performed after systemic therapy completion. Decision of further axillary dissection in breast conserving surgery (BCS) was based on Z0011 protocol. Patients are followed for locoregional recurrence, disease free survival and overall survival.


We studied a total of 76 patients, out of which 63 patients underwent BCS (83%) and 13 Patients underwent mastectomy (17%). SLN was successfully identified in all patients except one. Majority of patients were T2 at presentation (82%). Frozen section was negative in 51 patients (71%) and positive in 21 patients (29%). Out of 21 positive SLN, 11 underwent ALND while 10 did not. In 85% of patients total no of LNs removed were 03 or more. Follow-up was short, maximum 2 years and minimum 10 months. One patient showed local recurrence in breast at 6 months after surgery. Rest all were fine, follow-up is still going on.


Sentinel lymph node biopsy with Isosulfan blue dye alone is an acceptable method in resource-constrained countries, where unfortunately most patients still undergo axillary dissection irrespective of the clinical nodal status. This study may provide an incentive to such countries to adopt this simpler procedure to avoid long-term m

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