Anaphylactic shock after patent blue injection for SLNB in breast cancer

Abstract

Accuracy of SLNB varies between 93 and 99%, according to published data. Best results are achieved through combined detection of SLN with radioisotope and blue dye, allthough blue dye doesn't add much to the accuracy of SLNB (95,1% with radioisotope only and 98,9% with both tracers) According to some data, allergic reactions to blue dye were more often seen with methylene blue, whereas patent blue should cause significantly less problems and serious allergic reactions should not exceed 3%. In our hospital we performed 22 SLNB procedures due to breast cancer in year 2006, after introducing this procedure in our daily practice in january 2006. Additionally, we marked lymph nodes with patent blue injection into periareolar region. Careful needle aspiration was performed before dye application in order to avoid intravenous injection. Anyway, our data shows two serious cases of anaphylactic shock with the use of patent blue. Both patients, 59 and 75 years old females showed generalised urticaria with severe signs of anaphylactic shock during general anasthesia, 20–25 minutes after injection. Stabilisation of both patients was possible during operation and final outcome was good. Both patients were sent to evaluate hypersensitivity to blue dye. In order to avoid any further anaphylactic reactions (in our data as high as 9,1%) we may omit the use of blue dye and only use radioisotope for SNLB detection.