title: Sentinel lymph node biopsy in early breast cancer surgery--working with the risks of vital blue dye to reap the benefits.
abstract: OBJECTIVE
  Sentinel lymph node biopsy (SLNB) is an important method of staging early breast cancer because of the inherent benefits it confers on patients in terms of arm function and quality of life. Its success depends on a high level of accuracy in detecting the sentinel node. This is achieved by a dual mapping technique that employs a radio-labelled nanocolloid and a vital blue dye. The vital dyes however carry the risk of anaphylaxis, and as more surgeons employ SLNB in their daily practice, a proportionate rise in the number of anaphylactic reactions can be expected. A comprehensive review of risks and benefits associated with using vital blues dyes has not been published and therefore a retrospective review was undertaken of the different levels of anaphylaxis associated with vital dyes as well as their benefits in SLNB.
  
  
  METHODS
  An OVID MEDLINE search was performed of the English published literature using appropriate search terms to find published trial data and case series that focused on adverse reactions to vital blue dyes.
  
  
  RESULTS
  The risk of severe anaphylaxis (grade 3) can be as low as 0.06%, and up to 0.4% for patients undergoing SLNB when data is analysed from large trials. Furthermore, adverse reactions associated with blue dyes are reversible with appropriate management.
  
  
  CONCLUSIONS
  Surgeons should continue to use vital dyes to ensure that SLNB remains a highly sensitive procedure.
authors.affiliation: Department of Breast Surgery, Wansbeck General Hospital, Woodhorn Lane, Ashington NE63 9JJ, United Kingdom. vwhite@doctors.org.uk
authors.forename: V
authors.initials: V
authors.lastname: White
authors.forename: J R
authors.initials: JR
authors.lastname: Harvey
authors.forename: C D M
authors.initials: CD
authors.lastname: Griffith
authors.forename: M
authors.initials: M
authors.lastname: Youssef
authors.forename: M
authors.initials: M
authors.lastname: Carr
mesh_terms: D000707:Anaphylaxis / Q000139:chemically induced*; D001943:Breast Neoplasms / Q000473:pathology*; D004396:Coloring Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D009367:Neoplasm Staging; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects*
chemical_list: D004396:Coloring Agents