Adverse Effects of Intraparenchymal and Peritumoral Application of Isosulfan Blue Dye in Sentinel Lymph Node Mapping in Breast Cancer: A Systematic Review and Meta-Analysis
We investigate the evidence for adverse effects of intraparenchymal and peritumoral application of isosulfan blue dye in sentinel lymph node (SLN) mapping in breast cancer patients. A meta-analysis on the adverse effects of intraparenchymal and peritumoral application of isosulfan application in SLN...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Galenos Publishing House
2025-01-01
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| Series: | European Journal of Breast Health |
| Subjects: | |
| Online Access: | https://www.eurjbreasthealth.com/articles/adverse-effects-of-intraparenchymal-and-peritumoral-application-of-isosulfan-blue-dye-in-sentinel-lymph-node-mapping-in-breast-cancer-a-systematic-review-and-meta-analysis/doi/ejbh.galenos.2024.2024-8-1 |
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| Summary: | We investigate the evidence for adverse effects of intraparenchymal and peritumoral application of isosulfan blue dye in sentinel lymph node (SLN) mapping in breast cancer patients. A meta-analysis on the adverse effects of intraparenchymal and peritumoral application of isosulfan application in SLN mapping was conducted using Medline and Embase databases up to 2023. Procedure-based adverse reactions were divided into three grades: Grade I (allergic skin reactions), Grade II (hypotension) and Grade III (requiring vasopressor support). Heterogeneity was expressed with I-squared and tau statistics. Subgroup analysis was conducted for administrative route. Univariable meta-regression was performed to assess dose-response effect on adverse reactions. Sensitivity analysis was conducted using fixed effect modelling. A total of 19,183 patients were identified from eight studies. The pooled total adverse event rate after isosulfan administration was 11.65 events per 1,000 patients [95% confidence interval (CI) 7.44–18.19]. The rate of Grade I reactions was 7.96 per 1,000 (95% CI 4.08-15.46); Grade II 0.08 per 1,000 (95% CI 0.00–1.31), Grade III 1.86 per 1,000 (95% CI 0.94–3.66), with no reported mortalities. Intraparenchymal administration was associated with 15.16 events per 1,000 (95% 8.64–26.45), versus 7.04 events per 1,000 (95% CI 5.24–9.45) in peritumoral administration (p=0.02). Univariable meta-regression did not show a significant association between volume of dye infused and total adverse events (-0.164 events per mL, 95% CI -0.864 to 0.534, p=0.645). Isosulfan has low adverse event rates regardless of injection technique or volume administered. Clinicians should have a high level of confidence in its use as an agent for SLN mapping, especially when administering it peritumorally. |
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| ISSN: | 2587-0831 |