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 Feb;189(2):236-9. doi: 10.1016/j.amjsurg.2004.06.042.


Background: Sentinel 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.

Methods: A literature search for English language articles available on MEDLINE from 1985 to November 2002 using the search terms allergy, allergic reaction, anaphylactic reactions, anaphylaxis, blue dye, breast cancer, isosulfan blue, methylene blue, and sentinel lymph node biopsy identified 24 reports.

Conclusions: The use of isosulfan blue due for SLNB is associated with a significant number of allergic reactions, some of which are life-threatening. Because methylene blue dye has been shown to be equally effective and does not pose a serious risk of serious allergic reactions, it offers an improved technique above isosulfan blue dye for SLNB.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Axilla
  • Breast Neoplasms / pathology*
  • Drug Hypersensitivity*
  • Enzyme Inhibitors / adverse effects*
  • Female
  • Humans
  • Lymphatic Metastasis / diagnosis*
  • Methylene Blue / adverse effects*
  • Risk Factors
  • Rosaniline Dyes / adverse effects*
  • Sentinel Lymph Node Biopsy / adverse effects*
  • Sentinel Lymph Node Biopsy / methods


  • Enzyme Inhibitors
  • Rosaniline Dyes
  • iso-sulfan blue
  • Methylene Blue