Journal of Clinical Oncology, Vol 19, Issue 9
(May), 2001: 2573-2574
© 2001 American Society for Clinical Oncology
Unusual Aspects of Breast Cancer
Case 3. Blue Hives During Lymphatic Mapping for Breast Cancer
Henry Mark Kuerer,
Kelly K. Hunt,
S. Eva Singletary,
Frederick C. Ames
The University of Texas M.D. Anderson Cancer Center, Houston, TXCopyright © 2001 American Society of Clinical Oncology
A 75-year-old woman who had undergone lumpectomy for a 1.4-cm invasive ductal cancer 5 weeks earlier underwent lymphatic mapping and sentinel lymph node biopsy after injection of 5 mL of 1% isosulfan blue dye around the lumpectomy site. Two sentinel lymph nodes were identified, both of which were found to be free of metastases on pathologic examination. Forty minutes after injection of isosulfan blue, the patient exhibited diffuse severe blue urticaria ( Fig 1) and systemic hypotension. These symptoms responded rapidly to epinephrine, diphenhydramine, and corticosteroids.
Anaphylaxis is a severe systemic allergic reaction that generally manifests clinically as respiratory difficulty and hypotension. It results from massive release of preformed mediators such as histamine from mast cells and basophils. Release of these mediators is caused by either direct cellular triggering by a drug (anaphylactoid reaction) or cellular binding of specific immunoglobulin E antibodies (type 1 anaphylactic allergic reaction). This release produces capillary leakage and mucosal edema that may result in urticaria, laryngeal edema, bronchospasm, asthma, and hypotension. Isosulfan blue is a 2,5-disulfonated patent blue dye that was initially approved by the United States Food and Drug Administration for selective localization of the lymphatic system before radiocontrast procedures. Patent blue is used as a dye in some cosmetics, textiles, and detergents. Previous reports have indicated that approximately 1.5% of patients injected with isosulfan blue have an allergic reaction to this compound.1,2
Sentinel node biopsy is a major advance in the evaluation and treatment of breast cancer. However, no advance is without potential complications. Surgeons performing lymphatic mapping must be aware that severe allergic reactions may occur with the use of isosulfan blue, must recognize any reactions early, and must be prepared to treat the potentially life-threatening signs and symptoms that can occur with this compound.
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Longnecker SM, Guzzardo MM, Van Voris LP: Life-threatening anaphylaxis following subcutaneous administration of isosulfan blue 1%. Clin Pharm 4: 219-221, 1995
2.
Leong SP, Donegan E, Heffernon W, et al: Adverse reactions to isosulfan blue during selective sentinel lymph node dissection in melanoma. Ann Surg Oncol 7: 361-366, 2000[Abstract/Free Full Text]
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