Loading
To find the first lymph node a breast cancer drains to, UK surgeons inject a radioactive tracer and a blue dye. The blue dye is one of the causes of severe allergic reactions under anaesthesia and stains the skin. Pooled studies suggest a green fluorescent dye finds the node as well as the tracer and better than the two together, and that the blue dye does not lower the rate of missed cancer.
Current practice. NICE NG101 says to perform sentinel node biopsy using the dual technique with isotope and blue dye, a recommendation dated 2009.
The harm. The 6th National Audit Project found 266 severe perioperative allergic reactions in a year across UK NHS hospitals; of 199 identified culprits, nine were Patent Blue dye, with a delayed onset.
The evidence. A 2016 systematic review of 24 prospective studies found that adding blue dye to the isotope raised the node identification rate (OR 2.03) but did not significantly lower the false-negative rate (OR 0.76, 95% CI 0.44 to 1.29). A 2020 meta-analysis of 10 studies found indocyanine green fluorescence equivalent to isotope alone and superior to the dual technique and to blue dye alone at finding the node, and suggested hospitals could consider changing. Neither is a randomised trial of outcomes such as axillary recurrence.
The gap. How often UK units use blue dye has not been measured here; NICE has not updated the 2009 recommendation.
Shares Toxicity and quality of life are undervalued, Triple-negative breast cancer (TNBC), HR-positive / HER2-negative breast cancer and the tags protocol-upgrade, upgrade:promising.
Shares Magnetic tracer for sentinel lymph node biopsy (Magtrace and Sentimag), Sentinel node biopsy, Sentinel lymph node biopsy.
Shares Knowledge reaches practice too slowly, Toxicity and quality of life are undervalued and the tags protocol-upgrade, upgrade:promising.
Shares Toxicity and quality of life are undervalued, HER2-positive breast cancer and the tags protocol-upgrade, upgrade:promising.
Shares Toxicity and quality of life are undervalued, HR-positive / HER2-negative breast cancer and the tags protocol-upgrade, upgrade:promising.
Shares Knowledge reaches practice too slowly and the tags protocol-upgrade, upgrade:promising.
Shares Toxicity and quality of life are undervalued and the tags protocol-upgrade, upgrade:promising.
Shares Toxicity and quality of life are undervalued and the tags protocol-upgrade, upgrade:promising.
Every source this page cites, grouped by who published it. Grouping is read from the web address, not assigned by hand.
A source that has moved or gone is reported by the weekly link check. /audit/