Response to letter commenting on the use of blue dye in sentinel lymph node biopsy

We read with interest the reply from Rudman and colleagues1 to our publication2 but disagree with their assertion that blue dye must be used to increase the accuracy of sentinel lymph node biopsy (SLNB) for melanoma. In our series, the use of blue dye did not improve the sensitivity of intra-operative sentinel node identification but increased the number of nodes harvested by 5%. Our findings correspond with a meta-analysis performed by Niebling et al in 2016,3 where pooled analysis of 66 studies showed a 99% SLN identification rate using radiocolloid without blue dye.

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