Anaphylactic Reactions to Isosulfan Blue Dye During Sentinel Lymph Node Biopsy for Breast Cancer

Abstract

Background: The sentinel lymph node biopsy is an alternative to axillary dissection for many breast cancer patients. Cases of anaphylactic reaction to the isosulfan blue dye used during sentinel lymph node biopsy have recently been reported. To prospectively reduce the incidence and severity of adverse reactions to isosulfan blue dye, we evaluated the incidence of severe anaphylactic reactions to isosulfan blue dye during the performance of sentinel lymph node biopsy for breast cancer at our institution.

Methods: A retrospective chart review study enrolled 1,456 consecutive patients with breast cancer at our institution. Sentinel lymph node biopsy was performed using both isosulfan blue dye and technetium-99m sulfur colloid. Cases of anaphylaxis were reviewed in detail.

Results: Overall, 12 (0.8%) of the 1,456 patients had severe anaphylactic reactions. All 12 patients experienced cardiovascular collapse (profound hypotension and tachycardia) and skin reactions; and patients required admission to an intensive care unit bed or equivalent setting for postoperative monitoring. No deaths or permanent disability occurred.

Conclusions: Prompt recognition and aggressive treatment of anaphylactic reactions to isosulfan blue are critical to prevent an adverse outcome. Lymphatic mapping with blue dye should be performed in a setting where personnel are trained to recognize and treat anaphylaxis.




J Curr Surg. 2018;8(3-4):32-34
doi: https://doi.org/10.14740/jcs365w