A Comparison of Skin Staining after Sentinel Lymph Node Biopsy in Women Undergoing Breast Cancer Surgery Using Blue Dye and Superparamagnetic Iron Oxide Nanoparticle (SPIO) Tracers

Allan Jazrawi; Madeleine Wärnberg; Abdi-Fatah Hersi; Christine Obondo; Lida Pistioli; Staffan Eriksson; Andreas Karakatsanis; Fredrik Wärnberg

doi:10.3390/cancers14236017

A Comparison of Skin Staining after Sentinel Lymph Node Biopsy in Women Undergoing Breast Cancer Surgery Using Blue Dye and Superparamagnetic Iron Oxide Nanoparticle (SPIO) Tracers

Cancers (Basel). 2022 Dec 6;14(23):6017. doi: 10.3390/cancers14236017.

Authors

Allan Jazrawi^{1

2}, Madeleine Wärnberg³, Abdi-Fatah Hersi⁴, Christine Obondo⁵, Lida Pistioli⁶, Staffan Eriksson^{1

2}, Andreas Karakatsanis^{3

7}, Fredrik Wärnberg^{3

6

7}

Affiliations

¹ Centre for Clinical Research, County Västmanland, Uppsala University, 721 89 Västerås, Sweden.
² Department of Surgery, Västmanlands County Hospital, 721 89 Västerås, Sweden.
³ Department of Surgical Sciences, Uppsala University, 751 85 Uppsala, Sweden.
⁴ Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden.
⁵ Department of Surgery, Södersjukhuset, 118 83 Stockholm, Sweden.
⁶ Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden.
⁷ Department of Surgery, Section for Endocrine and Breast Surgery, Uppsala University Hospital, Akademiska Sjukhuset, 751 85 Uppsala, Sweden.

Abstract

Superparamagnetic iron oxide nanoparticles (SPIO) are a tracer for sentinel lymph node (SLN) detection. In a preplanned secondary analysis of a prospective clinical trial (SentiDose) we reported on skin staining after SPIO and blue dye (BD) injections. For SPIO, either a 1.5 mL retroareolar injection on the day of surgery or a 1.0 mL peritumoral/retroareolar injection 1-7 days before surgery was given. A 1.0 mL sub-/intradermal periareolar injection of BD was also administered to all these women. Staining was then assessed at 6, 12 and 24 months after surgery. A total of 270 women received SPIO and were operated on with breast-conserving surgery. Of these, 204 women also received BD. A total of 58 (21.5%) women had an SPIO stain 6 months postoperatively with a median size of 6.8 cm² (p = 0.56), while 51 (25.0%) had a BD stain with a median size of 8.5 cm² (p = 0.93). The incidence and size of SPIO and BD staining decreased over time reciprocally. At 24 months, the incidence and median size of SPIO was 23 (8.6%) and 4 cm², respectively. For BD, the incidence was 14 (6.3%, p = 0.13), and the median size was 3.5 cm² (p = 0.18). There was, therefore, no statistically significant difference in the incidence or size of skin staining between SPIO and BD over time.

Keywords: blue dye; breast cancer; magnetic tracer; sentinel lymph node; sentinel lymph node biopsy; skin staining; superparamagnetic iron oxide.

Grants and funding

Sysmex Europe GmbH and Endomagnetics, Cambridge, UK, provided the SentiMag^® device and Magtrace^® vials for the trial. Institutional grants by the Centre of Clinical Research, Region Västmanland, Uppsala University and the Västmanland Cancer Foundation are acknowledged. The study was partially funded by the Swedish Association for Breast Cancer (Bröstcancerförbundet). Sponsors had no role in the study design, data collection, analyses, or interpretation.