Can Sentinel Lymph Node Biopsy (SLNB) be Performed in Pregnant Women with Breast Cancer?

• SLNB is the standard of care:
  • In patients with localized, clinically node-negative breast cancer
• SLNB, compared to ALND:
  • Incurs lower risk of complications, including:
    • Arm pain
    • Paresthesias
    • Lymphedema
• The role of SLNB during pregnancy:
  • Is controversial:
    • Largely due to the lack of data on the impact of vital blue dyes and radiocolloid tracer on fetal well-being.
• Currently, if one chooses SLNB:
  • There are more data on the safety of radiocolloid as opposed to blue dyes:
    • One recent retrospective review of 81 clinically node-negative pregnant patients treated at a single institution:
      • Revealed a fairly even split between SLNB (53%) and upfront ALND (43%):
        • The remaining 4% had no lymph node surgery
    • Identification of a SLN was successful in all patients who underwent SLNB.
    • Technetium (99-Tc) alone:
      • Was used in the majority of those undergoing SLNB (16/25 patients).
    • Methylene blue dye alone:
      • Was used in 7/25 patients.
    • No maternal complications ensued, and gestational outcomes were excellent:
      • With 24/25 neonates born healthy:;
        • One neonate was born with a cleft palate in the context of other maternal risk factors.
  • Four other institutional studies have also demonstrated similar success and excellent maternal–fetal outcomes with SLNB during pregnancy:
    • Most of which used 99-Tc alone or in conjunction with blue dye.
  • Both isosulfan blue and methylene blue are pregnancy class C drugs:
    • Concern exists over the risk of allergic reaction and even anaphylaxis with isosulfan blue.
  • Models of fetal radiation exposure have calculated that:
    • The dose received by the fetus with 99-Tc for SLNB ranges from only 1.14 microGy to 4.3 microGy:
      • Whereas risk of fetal malformation is associated with levels exceeding 100 microGy.
• Based on this data:
  • It appears that SLNB is likely safe in pregnancy, with the caveat that no large, prospective trials have been or are likely to be performed given the rarity of breast cancer in this population.
• Despite this, the recently updated American Society of Clinical Oncology Guidelines on SLNB:
  • Still advise against SLNB in pregnant women due to insufficient data.
• Forthright conversations with pregnant patients must address the potential risks and benefits associated with each of the options presented above.

 

• REFERENCES

  • Gropper AB, Calvillo KZ, et al. Sentinel lymph node biopsy in pregnant women with breast cancer. Ann Surg Oncol. 2014;21:2506-2511.
  • Lyman GH, Temin S, Edge SB, Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2014;32):1365-1383.
  • Spanheimer PM, Graham MM, Sugg SL, et al. Measurement of uterine radiation exposure from lymphoscintigraphy indicates safety of sentinel lymph node biopsy during pregnancy. 

   

👉Rodrigo Arrangoiz MS, MD, FACScirujano oncology y miembro de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

• Es experto en el manejo del patología de mama:

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

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