Allergic Reactions to Patent Blue Dye in Sentinel Lymph Node Biopsy for Breast Cancer

Authors List

  1. Smith, M., Waikato Hospital, Hamilton, New Zealand. 2. Kerridge, T., Tauranga Hospital, Tauranga, New Zealand. 3.     Shirley, R., Waikato Hospital, Hamilton, New Zealand. 4. Edwards, M., Waikato Hospital, Hamilton, New Zealand. 5.    Hayes, L., Waikato Hospital, Hamilton, New Zealand. 6.        Stewart, A., Waikato Hospital, Hamilton, New Zealand. 7.       Creighton, J., Waikato Hospital, Hamilton, New Zealand. 8. Campbell, I., Waikato Hospital, Hamilton, New Zealand.

Introduction: Currently dual tracer technique with Patent Blue V Dye (PBD) and radionucleotide injection is the gold standard for identification of sentinel lymph nodes (SLN) in early breast cancer. (Elmadahm et al., 2015) However, PBD is associated with significant allergic events (Elmadahm et al., 2015). Preoperative skin prick testing has been proposed to predict those who have anaphylaxis to PBD.

Aim: The primary aim was to determine accurate allergy rates to PBD and analyse the efficacy of predictive skin testing.

Method
: Data collected by the Waikato Breast Cancer Research Trust from 1999-2016 on all women who underwent sentinel lymph node localisation procedure was analysed. PBD skin testing was performed preoperatively and skin reaction was assessed and recorded.

Results
: 1774 patients had SLN biopsy at Waikato Hospital between 1999-2016. An overall rate of anaphylaxis with PBD administration was 0.89%. There were 16 patients overall who had allergic reaction to PBD, of which 7 were anaphylaxis. The rate of anaphylaxis in those who underwent preoperative skin testing was 0.85%, and was 0.40% in those without (p = 0.91).

Conclusions
: This study showed that the anaphylaxis rate did not differ between the preoperative skin tested group and non-skin tested group. Additionally, preoperative skin prick testing failed to predict anaphylaxis in some women. The study challenges the utility of predictive testing. Given the significant potential morbidity with PBD anaphylaxis, selective use of PBD should be considered, especially in those who are at relatively low risk of having axillary node involvement, and those with higher SLN biopsy false positive rates.

References

Elmadahm, A. A., Gill, P. G., Bochner, M., Gebski, V. J., Zannino, D., Wetzig, N., Campbell, I., Stockler, M., Ung, Owen., Simes, J. & Uren, R. (2015). Identification of the sentinel lymph node in the SNAC-1 trial. ANZ Journal of Surgery, 85(1-2):58-63. https://doi.org/10.1111/ans.12527.

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