Axillary staging for breast cancer during pregnancy: feasibility and safety of sentinel lymph node biopsy

Breast Cancer Res Treat. 2018 Apr;168(2):551-557. doi: 10.1007/s10549-017-4611-z. Epub 2017 Dec 12.

Abstract

Background: Safety of sentinel lymph node (SLN) biopsy for breast cancer during pregnancy is insufficiently explored. We investigated efficacy and local recurrence rate in a large series of pregnant patients.

Patients and methods: Women diagnosed with breast cancer who underwent SLN biopsy during pregnancy were identified from the International Network on Cancer, Infertility and Pregnancy, the German Breast Group, and the Cancer and Pregnancy Registry. Chart review was performed to record technique and outcome of SLN biopsy, locoregional and distant recurrence, and survival.

Results: We identified 145 women with clinically N0 disease who underwent SLN during pregnancy. The SLN detection techniques were as follows: 99mTc-labeled albumin nanocolloid only (n = 96; 66.2%), blue dye only (n = 14; 9.7%), combined technique (n = 15; 10.3%), or unknown (n = 20; 13.8%). Mapping was unsuccessful in one patient (0.7%) and she underwent an axillary lymph node dissection (ALND). Mean number of SLNs was 3.2 (interquartile range 1-3; missing n = 15). Positive SLNs were found in 43 (29.7%) patients and 34 subsequently underwent ALND. After a median follow-up of 48 months (range 1-177), 123 (84.8%) patients were alive and free of disease. Eleven patients experienced a locoregional relapse, including 1 isolated ipsilateral axillary recurrence (0.7%). Eleven (7.6%) patients developed distant metastases, of whom 9 (6.2%) died of breast cancer. No neonatal adverse events related to SLN procedure during pregnancy were reported.

Conclusions: SLN biopsy during pregnancy has a comparably low axillary recurrence rate as in nonpregnant women. Therefore, this method can be considered during pregnancy instead of standard ALND for early-stage, clinically node-negative breast cancer.

Keywords: Breast cancer; Lymphoscintigraphy; Pregnancy; Sentinel lymph node.

MeSH terms

  • Adult
  • Axilla
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / mortality
  • Breast Neoplasms / pathology*
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Germany / epidemiology
  • Humans
  • Lymphatic Metastasis / diagnosis*
  • Lymphatic Metastasis / pathology
  • Maternal Exposure / adverse effects
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology*
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Staging
  • Observational Studies as Topic
  • Pregnancy
  • Pregnancy Complications / diagnosis
  • Pregnancy Complications / mortality
  • Pregnancy Complications / pathology*
  • Pregnancy Outcome
  • Radioactive Tracers
  • Registries / statistics & numerical data
  • Retrospective Studies
  • Sentinel Lymph Node / pathology
  • Sentinel Lymph Node Biopsy / adverse effects*
  • Sentinel Lymph Node Biopsy / methods
  • Technetium Tc 99m Aggregated Albumin / administration & dosage
  • Technetium Tc 99m Aggregated Albumin / adverse effects

Substances

  • Radioactive Tracers
  • Technetium Tc 99m Aggregated Albumin