Ashraf Farouk Abdeer1, Amr Mohamed Elhefny2, Wadie Boshra Gerges3,John Sobhy Mamlouk Sawires4
Ahmed Samir Hosny, Mohamed Hosny Ezz El Arab, AmrAbd El Rahim Mohamed
Ahmed Samir Hosny, Ahmed M. Elmahrouky
Hassan A.Saad, Kamal Rabi Eid, Tamer Mohamed Elshahidy
Hany M S Mikhail1 MD FRCS, Athar S M Elward MD, Tarek A. Awad1 M.Sc MRCS, Mohamed H.A. Fahmy1 MD., Ahmed Amr Mohsen2 M.Sc
Amer nasr, MD;1 Mohamed A.Safy El Deen2
Hazem Abdel Salam Mohamed; Fawzy Salah Fawzy; Fady Assem Awad Youssef
Nader M. Milad (M.D, MSc, MRCS, MBBCh.)1, Ahmed Kandeel(M.D, MSc, MBBCh.)2, Mahasen Abougabal (M.D, MSc, MBBCh.)2, Karim K. Maurice (M.D, MSc, MRCS, MBBCh.)1
Ehab H. Abd El-Wahab,MD; Ahmad Gamal El Deen,MD; Amr H. Afifi,MD
Haitham Akram Saimeh
Tamer.M.EL Gaabary, MD, Mohamed Shaaban, MSc., Salah.S. Soliman MD, MRCS,
Mina Nabil Rashied Manasseh; Ibrahim Magid Abdel-Maksoud; Yasser Abdel-Samee Mohammed
Omar Sherif Omar MD, Ahmed El Nogoomi M.B.B.C.H, Ahmed Mostafa Shazly MD, Mahmoud A. Ameen MD
Lateral versus Classical Blue Dye Injection in SLNB for Breast Cancer Patients
Background: Breast cancer is the most common type of cancer and the second leading cause of cancer
deaths among women. The evolution and the now widespread use of the SLNB as the gold standard for the
management of axillary disease in early breast cancer, as compared to the classic Axillary Lymph Node
Dissection has reduced morbidities related to the ALND. The classical sites for injection of the blue dye are
sub-areolar or peri-areolar and peri-tumoral. However, there is variable incidence of failure of
visualization of the dyed SLN in as many as 47% of attempted cases in some centers. Objective: Evaluation
of the lateral injection technique of blue dye as compared to the classical techniques in the identification of
the SLN in early breast cancer patients (Tis-T2). Methods: forty patients eligible for SLNB were included
in the study, twenty were subjected to the lateral injection technique (intra- parenchymal injection of 5 ml
of 1% patent blue dye in the UOQ) and twenty were subjected to the classical injection techniques (peritumoral or retro areolar). Results: The mean age of the study population was 49.28 ± years. SLNB was
done with 1% patent blue dye with an identification rate of 100% for both arms of the study. The median
number of colored lymph nodes that were retrieved through the lateral injection technique were 4 as
compared to a median of 2.5 lymph nodes retrieved through the classical injection, this difference was
statistically significant (p value=0.001). The number of palpable non colored lymph nodes encountered in
the control group (classical injection) was greater than those in the study group (p value=0.06). The
operative time with the lateral injection technique was shorter than the classical injection techniques, this
was statistically significant (p value=0.002). Conclusion: The use of 1% patent blue dye for SLNB is a
safe, easy and effective as compared to other tracers including radio-colloids. The lateral injection
technique is superior to the classical injection techniques as regarding the colored lymph node yield and
shorter operative time. There was no loco-regional recurrence after 6 months follow up (clinical and
ultrasound follow up). Further studies are needed to correlate between effect of the breast cup size, site of
injection and number of retrieved Colored lymph nodes.
Keywords: Lateral injection, SLNB, Retro-areolar injection, Peri-tumoral injection.