Marking Non-palpable Breast Masses with Injected Methylene Blue Dye, an Easy, Safe and Low Cost Method for Developing Countries and Resource-limited Areas

Introduction: The widespread use of improved mammographic techniques has led to increased detectionof nonpalpable breast masses. Preoperative localization is important for reducing false negative results anddecreasing the size of tissue resection needed and the resulting breast deformity. We used ultrasound guidedmethylen blue injection in the mass for localization of breast masses that were clinically nonpalpable butdetectable by ultrasound. Materials and methods : 57 masses from 51 patients were marked 20 to 180 minutesbefore surgery with 0.4-0.7 cc methylene blue and resection was done in operating room under local or generalanesthesia . success of radiologist for localization and success of surgeon for complete resection and pathologyresults were reviwed and fallow up ultrasound was done 3-5 month after surgery for patients whom pathologyreport was non specific (such as FCC) to confirm complete resection.
Results: 57 masses were excised successfullyby the surgeon , localization was successful in all patients but injection in the mass was not feasible in 4 patientsand dye was injected on the surface of the mass and led to successful excision .Only one mass was not found atsurgery because dye washed out before surgery, and the mass was resected by use of intra operative ultrasound.5.3% patients reported the procedure was painful and 28% reported tolerable pain during injection and 66.7% of patients said that the injection was painless or with minimal discomfort. Allergic reaction was not seen inany patient and no interference was reported by the pathologist in slide preparation or diagnoses and IHC study.
Conclusion: Marking with blue dye injection is a safe and low cost method for localization of non palpable breastlesions that are detectable by Ultrasound. In one patient failure to find the mass was because of location ofthe mass that was in axillary tail of breast and time of surgery that was 100 minutes after injection that led toabsorption of blue dye before surgery and it is advised to do surgery as soon as possible after blue dye injectionespecially in peripheral and deeply located masses.