Ultrasound-guided marker placement and blue dye staining for sentinel lymph node biopsy in early-stage breast cancer

PURPOSE: Ultrasound (US)-guided marker placement is an emerging method for sentinel lymph node biopsy (SLNB), and this study aimed to investigate the concordance between US-guided marker placement for peri-foraminal lymph nodes (LNs) in the axillary cribriform fascia and blue dye-stained SLNs, especially the utility of the two concurrent labeling methods for SLNB in patients with early-stage breast cancer. METHODS: Female patients with clinically staged T1-2N0M0 breast cancer were enrolled. Patients received US-guided marker placement on the day before surgery, followed by blue dye staining. SLN biopsy was performed on the blue dye-stained LNs first and then on the US-guided markers. RESULTS: A total of 96 eligible patients were enrolled. The detection rates of US-guided localization, blue dye, and their combination were 100.0%, 95.8%, and 100.0%, respectively. Among the 92 patients with blue dye staining, US-guided markers were found in blue-stained LNs from 91 patients (concordant) but failed in 1 patient (non-concordant); among the 4 patients without blue-stained LNs. US-guided markers were found in all 4 patients (non-concordant), resulting in a general concordance rate of 94.8% (91/96). Notably, among the 92 patients with blue dye staining, 23 had LN metastasis diagnosed through SLNB, whereas among the 4 patients without blue-stained LNs, the SLNB was performed based on US-guided markers, which revealed 3 patients with LN metastasis and 1 without. Moreover, combining the two labeling methods concurrently identified 26 patients with LN metastasis. CONCLUSION: US-guided localization combined with blue dye concurrently may be a satisfied option for SLNB detection. CLINICAL SIGNIFICANCE: US-guided localization combined with blue dye offers an accessible, anatomically grounded, and radiation-free strategy for optimizing the SLNB procedure, especially in settings where radioactive isotopes are not available.