Many studies have sought to determine the optimal technique for SLNB. Using a combination of isotope and blue dye for sentinel node localisation drastically reduces the rates of failed and false-negative procedures. In the ALMANAC study, the success rate of harvesting the SLN by blue dye alone was 86%, by radioactive mapping alone was 86%, and by a combination method was 96% (11). More importantly, in approximately 4% of patients the positive SLN was found by dye alone and in 3% by isotope alone; these would have been missed by relying on a single technique of localisation. This is in line with other studies which show that the combination of radiolabeled colloid, lymphoscintigraphy, and blue dye offers the highest success rate with the fewest false negatives (12, 17, 18). A small prospective randomised study in which the use of blue dye alone was compared with a combination of blue dye and radiolabeled colloid showed that the combined technique significantly improved the intraoperative SLN identification rate (100% vs. 86%; P = 0.002) (19).
Figure 3. Intradermal injection of radioisotope.
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