Anaphylactic response to blue dye during sentinel lymph node biopsy.

Area of Science:

• Oncology
• Surgical Pathology
• Clinical Immunology

Background:

• Sentinel lymph node (SLN) biopsy is standard for staging early breast cancer.
• Colorimetric and isotopic methods identify SLNs, often combined for higher accuracy.
• Adverse reactions to blue dyes used in colorimetric SLN identification have been reported.

Purpose of the Study:

• To determine the incidence of allergic and adverse reactions to blue dyes used in SLN procedures.
• To discuss alternative approaches for SLN identification.

Main Methods:

• A systematic literature search of MEDLINE and EMBASE databases was performed.
• The search focused on anaphylactic responses to isosulfan blue dye and patent blue V dye.
• Incidence rates of allergic reactions were analyzed.

Main Results:

• Allergic reactions to isosulfan blue and patent blue V dyes are rare, with reported incidences ranging from 0.07% to 2.7%.
• Methylene blue dye has shown no reported allergic events.
• Cross-reactivity between isosulfan blue and methylene blue dyes was observed in some patients.

Conclusions:

• The risk of anaphylaxis from blue dyes in SLN procedures is low.
• The potential cross-reactivity raises concerns about the safety and utility of colorimetric SLN detection.
• Alternative dyes like methylene blue warrant further investigation, considering potential cross-reactivity issues.