Patients blue on patent blue: An adverse reaction during four sentinel node procedures
E. Beenen, D.B.W. de Roy van Zuidewijn
Surgical Oncology
December 2005 (Vol. 14, Issue 4, Pages 151-154) Abstract |
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We read the paper by Dr. Beenen and van Zuidewijn with interest [1]. The incidence of blue dye allergy appears very variable. We have performed sentinel node biopsy using the combined blue dye and radiocolloid technique on 416 patients with breast carcinoma. In our series we have experienced a single blue dye allergy, manifesting as a transient blue urticarial skin reaction, with no drop in blood pressure. This gives an incidence of 0.24%. In addition a single patient in our series developed an urticarial reaction to nanocolloidal albumin.
Use of methylene blue as an alternative to patent blue or isosulphan blue has been suggested by several authors due to its wider availability, lower cost and reduced risk of allergy (though anaphylaxis has also been reported with methylene blue injection [2]). Acceptable sentinel node identification rates have been demonstrated in several series [3], [4], [5].
Methylene blue may however induce an intense tissue reaction, and superficial injection (such as intradermal and periareolar injection) may cause an intense skin reaction resulting in skin necrosis and ulceration [6], [7]. In addition there is a report of severe capsular contracture around an implant as a result of methylene blue injection [8]. It is postulated that the toxic effects of methylene blue are due to formation of aldehydes and deaminized oxidation products, which lead to macrophage activation and an intense inflammatory response. In addition, methylene blue causes vasospasm, due to inhibition of nitric oxide synthesis [9].
With the trend towards superficial injection of dyes for sentinel node identification, this important technical point should be emphasized.
References
[1]. [1]Beenen E, de Roy van Zuidewijn DB. Patients blue on patent blue: an adverse reaction during four sentinel node procedures. Surgical Oncology. 2006;.
[2]. [2]Dewachter P, Mouton-Faivre C, Trechot P, Lleu JC, Mertes PM. Severe anaphylactic shock with methylene blue instillation. Anesthesia and Analgesia. 2005;101(1):149–150table. MEDLINE |
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[3]. [3]Simmons RM, Smith SM, Osborne MP. Methylene blue dye as an alternative to isosulfan blue dye for sentinel lymph node localization. Breast Journal. 2001;7(3):181–183.
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[4]. [4]Eldrageely K, Vargas MP, Khalkhali I, Venegas R, Burla M, Gonzalez KD, et al.Sentinel lymph node mapping of breast cancer: a case–control study of methylene blue tracer compared to isosulfan blue. American Surgeon. 2004;70(10):872–875. MEDLINE
[5]. [5]Nour A. Efficacy of methylene blue dye in localization of sentinel lymph node in breast cancer patients. Breast Journal. 2004;10(5):388–391.
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[6]. [6]Salhab M, Al Sarakbi W, Mokbel K. Skin and fat necrosis of the breast following methylene blue dye injection for sentinel node biopsy in a patient with breast cancer. International Seminars in Surgical Oncology. 2005;2:26.
[7]. [7]Stradling B, Aranha G, Gabram S. Adverse skin lesions after methylene blue injections for sentinel lymph node localization. American Journal of Surgery. 2002;184(4):350–352. Abstract | Full Text |
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[8]. [8]Singh-Ranger G, Mokbel K. Capsular contraction following immediate reconstructive surgery for breast cancer—an association with methylene blue dye. International Seminars in Surgical Oncology. 2005;1(3):1–3.
[9]. [9]Stradling B, Aranha G, Gabram S. Adverse skin lesions after methylene blue injections for sentinel lymph node localization. American Journal of Surgery. 2002;184(4):350–352. Abstract | Full Text |
Full-Text PDF (32 KB)
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Department of Surgery, Royal Free and University College Medical School, 74 Huntley Street, London, WC1E 6AU, UK
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