WTP5.03 Assessing the Risk of Anaphylaxis with Blue Dye in Sentinel Node Biopsy: Is the Benefit Worth the Risk?Results from the Sentinel node Tracer Adverse Reaction Study (STARS)

Introduction Advancement in radiological methods and surgeon experience has improved sensitivity of sentinel lymph node biopsy (SLNB). Blue dyes have been associated with a risk of anaphylaxis making its routine use for SLNB questionable. Recent data demonstrates that adding blue dye provides only minimal improvement in SLNB identification. Methods An electronic survey was developed and distributed to senior breast surgeons at different breast units within the UK using Association of Breast Surgery, Mammary Fold and social media channels for breast surgical opinion regarding use of Blue Dye in SLNB. Results 69 responses were received from 46 different UK breast units (consultant=34, peri-CCT fellow=18, specialist trainee=11, other=6. 55% (n=38) of respondents use dual tracer (majority with blue dye and radioisotope) whilst 45% (n=31) use single tracer (n=25 radioisotope, n=6 Magtrace). Of those using radioisotope, 20%(n=14/62) use lymphoscintigraphy. Two main reasons for blue dye use were to improve identification 42% (n=29) and departmental policy 33% (n=23). 90% (n=62) of respondents didn’t know or overestimated the improvement in false negative rate (FNR) with addition of blue dye. The most severe reaction to blue dye experienced by respondents was allergy 22% (n=15) or anaphylaxis 57% (n=39) of which 59% (n=23/39) required ITU admission. Most surgeons, 80% (n=55), didn’t agree blue dye is needed as a routine tracer. Conclusion Dual tracer use minimally improves sensitivity of SLNB identification but increases the risk of adverse reaction to patients. Most surgeons believe that routine use of blue dye isn’t necessary, with variable use across the UK.