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View Full Version : certain dyes used 4 sentinel node (Identification) biopsy causes false ER negativity


Lani
06-15-2007, 01:19 PM
or lower ER positivity than the true value. One of these dyes was methylene blue in certain concentrations--

The presence of ER in breast cancer is an established prognostic marker determining the likelihood of response to anti-hormonal therapy. PR is a marker of ER functionality. ER-positive and PR-positive tumours are more likely to respond to anti-hormonal treatment than ER-positive and PR-negative tumours; there is some evidence that ER-positive and PR-negative tumours are more likely to respond to aromatase inhibitors than tamoxifen.9–11 In this study, we have explored the hypothesis that the dyes used in SLNB could interfere with hormonal receptor determination. A significant diminution in scoring was seen with cells treated with MB at 1:10 and 1:100 dilutions, with some samples rendered negative. This was not seen with PBV and IDC (table 1). These results suggest that an inherently weak ER expresser could be rendered negative after exposure to MB with consequent withholding of potentially beneficial treatment. However, it is difficult to accurately relate in vitro findings to an in vivo situation. No similar effect was seen on the results of MNF116 immunolabelling, and the effects of these dyes on other markers would need case-by-case evaluation.

Lani
06-15-2007, 01:20 PM
: J Clin Pathol. 2007 Jun;60(6):730-2.
Adverse effects of dyes used in sentinel node biopsy on immunocytochemical determination of hormone receptors in breast cancer cells.

Masannat YA, Shaaban AM, Speirs V, Coast G, Jackson P, Horgan K, Hanby AM.
Department of General Surgery, The Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK.
PMID: 17557875 [PubMed - in process]

Mary Jo
06-15-2007, 07:08 PM
Very interesting Lani. Thanks so much for sharing. At my initial diagnosis I was told I was er/pr positive. Also her2 positive. After surgery, (I had sentinel node mapping using blue dye) I was told I was er/pr neg. When the lab in our area was questioned on my positive status they said it was a typo. However, now I am concerned. My oncologist had my hormone receptor status checked a total of 3 times and each time it was negative. However, if the blue dye interferred I wonder now. I forwarded this link to my surgeon for her to check into for me.

Thanks so much for sharing.

Mary Jo

juanita
06-15-2007, 07:11 PM
Is there a way to find out if the dye interfered? I was told I was er/pr-, but would like to know if that was right.

Lani
06-15-2007, 08:22 PM
false (ER) negatives and only in certain concentrations.

I believe there are other ways to check ER status, which would not be interfered with by the dye. Best to ask your surgeon to check with the pathologist. Some of these other tests may only be done at cancer centers rather than community hospitals, but most of these allow pathological second opinions by sending in your slides.

I did not mean to worry people, rather make them aware that their ER status might deserve to be reexamined if it would alter their treatment if methylene blue dye in the worrisome concentrations were used.

Be sure when given an opinion, that the person giving it has read the full article. I don't believe it is free online(sorry if I am wrong, although it would be great if I am), so many may not want to pay the $25 or so to access it before giving the opinion.