Department of Ear, Nose and Throat Surgery, Morriston Hospital, Swansea, UK.
Department of Breast Surgery, Cardiff and Vale University Health Board, University Hospital Llandough, Llandough, UK.
Ann Surg. 2021 Jun 1;273(6):1087-1093. doi: 10.1097/SLA.0000000000004061.
The primary objective of this study was to quantify the risk of anaphylaxis to blue dyes used in SLNB for cancer. Secondary outcomes included the identification of factors that may influence this risk.
Blue dyes are widely used to help identify sentinel lymph nodes in oncological surgery. The rate of severe allergic reactions to blue dyes remains a controversial topic, with the true incidence and influencing factors uncertain.
A systematic review and meta-analysis was performed to identify all studies which report on the incidence of severe adverse reactions and anaphylaxis to blue dyes (patent blue, isosulfan blue, methylene blue, and indigo carmine), when used for SLNB. Collected data included cancer and dye type, volume, and method of injection. Incidence was estimated using the arcsine method of statistical analysis.
One hundred nine studies documenting 94 episodes of anaphylaxis in a total of 61,951 SLNB procedures, resulting in a weighed anaphylaxis rate of 0.061%. SLNB for breast cancer carries an anaphylaxis risk of 0.083%, with the risk markedly lower in melanoma surgery (0.0043%). Low dye volume (<2 mL) and intradermal injection are both associated with lower rates of anaphylaxis (0.031% and 0.0068%). Isosulfan blue seems to be the most anaphylactogenic amongst blue dyes with a rate of 0.16%. There were no reported cases of death in this cohort.
Anaphylaxis to blue dyes in SLNB is rare. Methylene blue, patent blue, lower dye volumes, and intradermal administration are all associated with a lower incidence of anaphylaxis.
本研究的主要目的是量化用于癌症 SLNB 的蓝色染料引起过敏反应的风险。次要结果包括确定可能影响这种风险的因素。
蓝色染料广泛用于帮助识别肿瘤手术中的前哨淋巴结。对蓝色染料严重过敏反应的发生率仍然是一个有争议的话题，确切的发生率和影响因素尚不确定。
进行了系统评价和荟萃分析，以确定所有报告蓝色染料（专利蓝、异硫蓝、亚甲蓝和靛胭脂）用于 SLNB 时严重不良反应和过敏反应发生率的研究。收集的数据包括癌症和染料类型、体积和注射方法。使用统计分析的反正弦法估计发生率。
109 项研究记录了 94 例过敏反应，共涉及 61951 例 SLNB 手术，加权过敏反应率为 0.061%。乳腺癌的 SLNB 过敏反应风险为 0.083%，黑色素瘤手术的风险明显较低（0.0043%）。低染料量（<2ml）和皮内注射与较低的过敏反应率相关（0.031%和 0.0068%）。异硫蓝似乎是蓝色染料中最具过敏反应性的染料，发生率为 0.16%。在该队列中没有报告死亡病例。
SLNB 中蓝色染料的过敏反应罕见。亚甲蓝、专利蓝、较低的染料量和皮内给药均与过敏反应发生率降低相关。
