Assessment of sensitivity of low-cost fluorescein as an alternative to radiocolloid for sentinel lymph node biopsy in breast carcinoma.

Background: Sentinel lymph node biopsy (SLNB) is important in the treatment and staging of early-stage breast carcinoma. Traditional methods, including blue dyes and radiocolloids, are limited by high cost, radiation safety concerns, and reliance on nuclear medicine centers. Low-cost fluorescent dye, fluorescein, has been suggested as a potential alternative due to its safety, ease of visualization, and low cost. This study aimed to find the sensitivity of fluorescein as an alternative to radiocolloid in SLNB for breast carcinoma. Materials and methods: A prospective observational study was done at a tertiary care teaching hospital in 50 female patients of early-stage breast carcinoma. Intraoperative injection of fluorescein and visualization with ultraviolet (UV) light were done. Sentinel nodes were detected with a hand-held UV light source. Results: Fluorescein detected sentinel nodes in 96% of patients. Fluorescein had a sensitivity of 96%, specificity of 98%, and 4.2% false-negative rate (FNR). Negative predictive value (NPV) was 98.5%. No significant adverse effects were noted. Conclusions: Fluorescein is a safe, cost-effective, and efficient replacement for radiocolloid in SLNB in breast cancer. It provides outstanding identification rates, sensitivity, and specificity and can be utilized to the best in low-resource settings. Multicenter trials are required to confirm these findings and promote more widespread adoption of fluorescein-based SLNB in clinical care.