Abstract 90P
Background
Current UK guidelines recommend Sentinel Lymph Node Biopsy (SLNB) using dual tracer technique (DTT) with pre-operative Tc-99 radioisotope (identifying ‘hot’ node) and intraoperative Patent Blue V Dye (identifying ‘blue’ node). The reported literature quotes 0.05 to 0.1% anaphylaxis rate to Patent Blue V Dye (PBVD). We anecdotally noted a recent increase in anaphylaxis to PBVD resulting in cardiopulmonary resuscitation and admission to ICU. To assess the balance of risk versus benefit, we reviewed our unit’s SLNB data to (1) identify the proportion of patients experiencing anaphylaxis to PBVD, and (2) to assess the added benefit of PBVD over Tc-99 alone.
Methods
A retrospective review of prospectively collected data was conducted over a 2-year period (2022-2023) including all consecutive patients who underwent SLNB for breast cancer. Patients with incomplete documentation were excluded. Incidence of anaphylaxis proven to PBVD was reviewed. Information on sentinel nodes was categorised as ‘hot only’, ‘hot and blue’ and ‘blue only’ nodes. Macro-positivity for each group was checked to assess localisation technique.
Results
Out of 639 patients who had SLNB, 580 patients with clear documentation were included. Of these, 3 patients (0.52%) suffered severe anaphylaxis to PBVD needing ICU admission. In total, 1013 sentinel nodes (SN) were included in the data analysis; 815 (80.5%) were hot and blue, 155 (15.3%) were hot only and 43 (4.2%) were blue only. Therefore, SN identification rate with Tc-99 was 95.8% and PBVD was 84.7% Macrometastases were present in 75 nodes, of which 58 (77.3%) were both hot and blue, 15 (20.0%) were hot only and 2 (2.7%) were blue only, with a total of 73 (97.3%) malignant hot nodes and 60 (80.0%) malignant blue nodes. The two ‘blue only’ nodes were from separate patients and in one of them, the ‘blue only’ node was the singular positive sentinel node.
Conclusions
In this series, the rate of anaphylaxis from blue dye (3/580) was comparable to the contribution of blue dye alone to SLNB staging (2/580). Larger data is needed to evaluate this with greater confidence. The results will however be helpful for surgical planning and informed decision making.
Drs. Luxmanan and James Rushton have equally contributed to the study.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.