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A comparison of the adverse reactions associated with isosulfan blue versus methylene blue dye in sentinel lymph node biopsy for breast cancer

2008; Elsevier BV; Volume: 195; Issue: 2 Linguagem: Inglês

10.1016/j.amjsurg.2007.03.008

1879-1883

Fatih Aydoğan, Varol Çelik, Cihan Uras, Ziya Salihoğlu, Ufuk Topuz,

Breast Implant and Reconstruction

We read the article published in the American Journal of Surgery in 2005, by Thevarajah et al [ [1] Thevarajah S. Huston T.L. Simmons R.M. A comparison of the adverse reactions associated with isosulfan blue versus methylene blue dye in sentinel lymph node biopsy for breast cancer. Am J Surg. 2005; 189: 236-239 Abstract Full Text Full Text PDF PubMed Scopus (160) Google Scholar ], about the side effects of the dye used to examine the sentinel lymph-node biopsy specimens for breast cancer. Singh-Ranger and Mokbel [ [2] Singh-Ranger G. Mokbel K. Capsular contraction following immediate reconstructive surgery for breast cancer–An association with methylene blue dye. Int Semin Surg Oncol. 2004; 1: 3 Crossref PubMed Scopus (18) Google Scholar ] showed another side effect, ie, capsular contraction caused by the methylene blue dye administered after immediate reconstructive surgery for breast cancer in their study. Alteration in oxygen saturation is another side effect of the dye used for examination of the sentinel lymph node biopsy specimens. Certain vital dyes are known to alter the light absorbency of blood, mimicking pulse oximeter desaturations, which may be misinterpreted as arterial desaturations. El-Tamer et al [ [3] El-Tamer M. Komenaka I.K. Curry S. et al. Pulse oximeter changes with sentinel lymph node biopsy in breast cancer. Arch Sur. 2003; 138: 1257-1260 Crossref PubMed Scopus (17) Google Scholar ] demonstrated that isosulphan blue decreased the oxygen saturation of their study of 92 breast cancer patients who underwent sentinel lymph node biopsy with isosulphan blue. Pinero et al [ [4] Pinero A. Illana J. Garcia-Palenciano C. et al. Effect on oximetry of dyes used for sentinel lymph node biopsy. Arch Surg. 2004; 139: 1204-1207 Crossref PubMed Scopus (36) Google Scholar ] showed that methylene blue caused fewer alterations of oxygen saturation compared with isosulphan blue on a prospective study. We also have reviewed the complete anaesthesia records of 140 patients who underwent sentinel lymph node biopsy with intraparanchymal injection of isosulphan blue and methylene blue in our clinic. The results also showed that methylene blue caused fewer changes on oxygen saturations compared with isosulphan blue. Oxygen saturation changes are more important, in particular, in patients with pulmonary diseases. In conclusion, we believe that methylene blue should be preferred in patients, but that if methylene blue and isosulphan blue must be used, close monitoring of oxygen saturation is required. A comparison of the adverse reactions associated with isosulfan blue versus methylene blue dye in sentinel lymph node biopsy for breast cancerThe American Journal of SurgeryVol. 189Issue 2PreviewSentinel lymph node biopsy (SLNB) is an established means of staging the axilla in patients with breast cancer. Recently, methylene blue dye has been shown to be an efficacious and cost-effective alternative to isosulfan blue. With the increasing popularity of SLNB, the potential complications of isosulfan blue use must be appreciated. Full-Text PDF