Incidence of Blue Dye Associated Anaphylaxis in Sentinel Lymph Node Biopsy
Association of Breast Surgery ePoster Library. Elsaid N. 05/13/19; 257196; P154
Dr. Nada Elsaid
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P154
Topic: Surgical techniques
INTRODUCTION: A combined technique, with radioisotope and Patent Blue V, is the gold standard for lymph node detection in sentinel biopsy. Increasingly, there has been reluctance to use blue dye, owing to a fear of complications, namely anaphylaxis. What is noteworthy, however, is that patients who undergo a general anaesthetic are often exposed to a myriad of drugs given sequentially and this makes diagnostic certainty in cases of anaphylaxis a challenge. METHODS: In this study, the incidence of anaphylaxis among patients who underwent a biopsy using the dual technique over the preceding 5 years at our centre was evaluated. Local approval was obtained and data was collected from the patient administration system which is made robust by a dedicated team of clinical coders. Allergy testing was requested in each case of anaphylaxis to elucidate the causative agent. RESULTS: Our findings demonstrated a total of 5 cases of anaphylaxis among the 1311 procedures that were performed in this period. Follow up of these patients revealed that only one successfully underwent allergy testing. This patient was found not to be allergic to the blue dye and further testing revealed the culprit to be the antibiotic teicoplanin, given peri-operatively. CONCLUSION: We conclude that individual cases of anaphylaxis should be judiciously scrutinised so as to prevent a presumption of blue dye related anaphylaxis. Indeed, the incidence of allergic reactions to dye has been reported to be as low as 0.07%. Current practice should therefore continue to employ a combined approach to improve detection rates.
Topic: Surgical techniques
INTRODUCTION: A combined technique, with radioisotope and Patent Blue V, is the gold standard for lymph node detection in sentinel biopsy. Increasingly, there has been reluctance to use blue dye, owing to a fear of complications, namely anaphylaxis. What is noteworthy, however, is that patients who undergo a general anaesthetic are often exposed to a myriad of drugs given sequentially and this makes diagnostic certainty in cases of anaphylaxis a challenge. METHODS: In this study, the incidence of anaphylaxis among patients who underwent a biopsy using the dual technique over the preceding 5 years at our centre was evaluated. Local approval was obtained and data was collected from the patient administration system which is made robust by a dedicated team of clinical coders. Allergy testing was requested in each case of anaphylaxis to elucidate the causative agent. RESULTS: Our findings demonstrated a total of 5 cases of anaphylaxis among the 1311 procedures that were performed in this period. Follow up of these patients revealed that only one successfully underwent allergy testing. This patient was found not to be allergic to the blue dye and further testing revealed the culprit to be the antibiotic teicoplanin, given peri-operatively. CONCLUSION: We conclude that individual cases of anaphylaxis should be judiciously scrutinised so as to prevent a presumption of blue dye related anaphylaxis. Indeed, the incidence of allergic reactions to dye has been reported to be as low as 0.07%. Current practice should therefore continue to employ a combined approach to improve detection rates.
P154
Topic: Surgical techniques
INTRODUCTION: A combined technique, with radioisotope and Patent Blue V, is the gold standard for lymph node detection in sentinel biopsy. Increasingly, there has been reluctance to use blue dye, owing to a fear of complications, namely anaphylaxis. What is noteworthy, however, is that patients who undergo a general anaesthetic are often exposed to a myriad of drugs given sequentially and this makes diagnostic certainty in cases of anaphylaxis a challenge. METHODS: In this study, the incidence of anaphylaxis among patients who underwent a biopsy using the dual technique over the preceding 5 years at our centre was evaluated. Local approval was obtained and data was collected from the patient administration system which is made robust by a dedicated team of clinical coders. Allergy testing was requested in each case of anaphylaxis to elucidate the causative agent. RESULTS: Our findings demonstrated a total of 5 cases of anaphylaxis among the 1311 procedures that were performed in this period. Follow up of these patients revealed that only one successfully underwent allergy testing. This patient was found not to be allergic to the blue dye and further testing revealed the culprit to be the antibiotic teicoplanin, given peri-operatively. CONCLUSION: We conclude that individual cases of anaphylaxis should be judiciously scrutinised so as to prevent a presumption of blue dye related anaphylaxis. Indeed, the incidence of allergic reactions to dye has been reported to be as low as 0.07%. Current practice should therefore continue to employ a combined approach to improve detection rates.
Topic: Surgical techniques
INTRODUCTION: A combined technique, with radioisotope and Patent Blue V, is the gold standard for lymph node detection in sentinel biopsy. Increasingly, there has been reluctance to use blue dye, owing to a fear of complications, namely anaphylaxis. What is noteworthy, however, is that patients who undergo a general anaesthetic are often exposed to a myriad of drugs given sequentially and this makes diagnostic certainty in cases of anaphylaxis a challenge. METHODS: In this study, the incidence of anaphylaxis among patients who underwent a biopsy using the dual technique over the preceding 5 years at our centre was evaluated. Local approval was obtained and data was collected from the patient administration system which is made robust by a dedicated team of clinical coders. Allergy testing was requested in each case of anaphylaxis to elucidate the causative agent. RESULTS: Our findings demonstrated a total of 5 cases of anaphylaxis among the 1311 procedures that were performed in this period. Follow up of these patients revealed that only one successfully underwent allergy testing. This patient was found not to be allergic to the blue dye and further testing revealed the culprit to be the antibiotic teicoplanin, given peri-operatively. CONCLUSION: We conclude that individual cases of anaphylaxis should be judiciously scrutinised so as to prevent a presumption of blue dye related anaphylaxis. Indeed, the incidence of allergic reactions to dye has been reported to be as low as 0.07%. Current practice should therefore continue to employ a combined approach to improve detection rates.
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