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Adrian G. Dan, MD; Sukamal Saha, MD, FACS, FRCS; Keith M. Monson, MD; David Wiese, MD; Elie Schochet, MD; Kimberly R. Barber, PhD; Balvant Ganatra, MD; Delip Desai, MD; Sunil Kaushal, MD

Arch Surg. 2004;139:1180-1184.

Hypothesis  Ten percent fluorescein may be successfully used as an alternative to 1% Lymphazurin (1% isosulfan blue; US Surgical Corp, North Haven, Conn) in sentinel lymph node (SLN) mapping for the accurate staging of colorectal tumors.

Design  Review of prospectively gathered data.

Setting  University-affiliated regional medical center.

Patients  Sentinel lymph node mapping was performed in 120 consecutive patients with colorectal malignancies.

Interventions  The first 1 to 4 blue nodes detected within 5 minutes were designated as Lymphazurin-detected SLNs. The first 1 to 4 fluorescent nodes seen under the Wood light were designated as fluorescein-detected SLNs. Multilevel serial sections for hematoxylin-eosin and immunohistochemistry studies for cytokeratin were performed on all SLNs.

Main Outcome Measures  Successful mapping, accuracy, skip metastasis, adverse reactions, occult micrometastases detection, and cost.

Results  Mapping was successful using Lymphazurin in 99% of the patients vs 97% of the patients using fluorescein (P =.89). The accuracy of predicting nodal metastases with each tracer was 95.8% vs 93.1%, respectively (P =.82). The skip metastases rate was 4.2% for Lymphazurin vs 6.9% for fluorescein (P =.37). The 5 patients in whom nodal disease was only identified as occult micrometastasis in the SLNs had a total of 5 SLNs, all of which were identified by both tracers. No adverse reactions occurred. The cost for Lymphazurin was $99.00, while the cost for fluorescein was $2.10.

Conclusions  With the exception of cost, there were no statistically significant differences between the 2 dyes. While easy availability and lower cost remain distinct advantages of fluorescein, Lymphazurin remains the gold standard. In patients with known hypersensitivity to Lymphazurin and when availability and cost are an issue, fluorescein may be used effectively for SLN mapping in colorectal tumors.

Author Affiliation: Department of Surgery, Michigan State University, McLaren Regional Medical Center, Flint.

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