Methylene blue dye as an alternative to isosulfan blue dye for sentinel lymph node localization

Ann Surg Oncol. 2003 Apr;10(3):242-7. doi: 10.1245/aso.2003.04.021.


Background: Our study describes the use of methylene blue dye as an alternative to isosulfan blue dye to identify the sentinel lymph node (SLN).

Methods: A retrospective analysis was performed of 112 breast cancer patients (113 axillae) who underwent SLN biopsy (SLNB) with methylene blue dye and (99m)Tc-labeled sulfur colloid for SLN identification. All SLNs were submitted for intraoperative frozen section analysis, hematoxylin and eosin stain, and immunohistochemical evaluation. Patients with a pathologically negative SLN did not undergo further axillary lymph node dissection.

Results: Of 112 patients who underwent SLNB, the SLN was identified in 107 (95.5%); 104 (92.8%) were identified by methylene blue dye. In a subset of 99 patients with recorded isotope status in relation to blue nodes, concordant identification with both dye and isotope was observed in 94 (94.9%). Of patients with identified SLNs, 32 (29.9%) of 107 contained metastatic disease, with 31 (96.9%) of 32 identified by methylene blue dye. The SLN was the only positive node in 18 (60.0%) of 30 patients.

Conclusions: SLNB with methylene blue dye is an effective alternative to isosulfan blue dye for accurately identifying SLNs in breast cancer patients.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / pathology*
  • Breast Neoplasms / surgery
  • Enzyme Inhibitors*
  • Female
  • Humans
  • Lymphatic Metastasis / diagnosis*
  • Methylene Blue*
  • Middle Aged
  • Neoplasm Staging
  • Retrospective Studies
  • Rosaniline Dyes*
  • Sensitivity and Specificity
  • Sentinel Lymph Node Biopsy / methods*


  • Enzyme Inhibitors
  • Rosaniline Dyes
  • iso-sulfan blue
  • Methylene Blue