Is massage necessary for the detection of the sentinel lymph node after isosulfan blue injection in breast cancer patients?

Objective: Breast cancer is the most commonly diagnosed cancer in women. The status of axillary lymph nodes in breast cancer patients is an important indicator in determining the treatment protocol and prognosis. Sentinel lymph node biopsy (SLNB) is used in the evaluation of axillary lymph node involvement. One of the methods used to detect the sentinel lymph node is the injection of Isosulfan Blue. There are studies suggesting that massaging the breast after applying the dye may increase the likelihood of tumor cell spread and may not be necessary. In this study, considering the possibility of massage increasing the spread of tumor cells and the delay in starting surgery after the patient's anesthesia induction, we investigated whether massage is truly necessary for SLNB. Method: Between December 2021 and June 2023, 77 female patients diagnosed with breast cancer at MCBÜ Hafsa Sultan Hospital Departmant of General Surgery, with no clinical axillary involvement and planned for sentinel lymph node biopsy, were included in the study. The patients were divided into two groups: one group received breast massage, and the other group did not receive any massage. After the injection of Isosulfan Blue, the presence or absence of the sentinel lymph node was investigated in both groups. The patients' ages, body mass indexes, breast cup sizes, pathological diagnoses, number of surgical incisions, and time taken to find the sentinel lymph node were recorded. Results: The study included 77 female patients, who were divided into two groups: those who received breast massage and those who did not. Out of the 77 patients, 40 received massage, while 37 did not. In the group that received massage, 2.5% did not have a sentinel lymph node detected, whereas in the group that did not receive massage, 8.1% did not have a sentinel lymph node detected. The data were processed using IBM SPSS Statistics 24 software. There was no statistically significant difference between the presence or absence of the sentinel lymph node and whether massage was performed or not (p=0.346). The patients were evaluated separately in terms of age, body mass index, breast cup size, pathological diagnosis, and the number of surgical incisions. Based on these parameters, the analysis comparing the group that received massage with the group that did not receive massage showed no statistically significant difference in the detection of the sentinel lymph node. Among patients aged 65 and above, the average time to detect the sentinel lymph node was 6 minutes in the group that received massage and 10.87 minutes in the group that did not receive massage. The difference between the two groups was statistically significant (p=0.015). Conclusion: As a result, in breast cancer patients, it is not necessary to perform massage after the injection of isosulfan blue to find the sentinel lymph node. All 4 patients who were unable to find the sentinel lymph node had a BMI of 30 and above. This finding suggests that factors other than massage may also play a role in finding the sentinel lymph node. To clearly determine this situation, we believe that prospective randomized studies are necessary Key words: Breast Cancer, Sentinel lymph node biopsy, Isosulfan blue, Massage.