Our Summary

Breast cancer during pregnancy is uncommon, but it does occur in 1 in 10,000 to 3,000 pregnancies. When a pregnant woman has early-stage breast cancer without obvious signs of spreading to the lymph nodes, doctors are uncertain whether to perform a sentinel lymph node (SLN) biopsy, a procedure to check if the cancer has spread. This is because it hasn’t been thoroughly studied in pregnant patients.

The standard practice of injecting blue dye for this procedure is not recommended in pregnancy because of a small risk of a severe allergic reaction. However, studies have shown that using a different substance for the injection (Tc99m) exposes the fetus to a very low level of radiation, much lower than the maximum recommended threshold.

The research also shows that this procedure doesn’t seem to have a negative effect on the pregnancy or the baby’s health. However, more studies with larger groups of patients are needed to confirm these findings and to provide clear guidance for doctors on whether to use this procedure in pregnant women.

In the meantime, the potential benefits for the mother and the low risk to the baby suggest that this procedure can be considered on a case-by-case basis, with a team of cancer experts involved in the decision.

FAQs

  1. What is a sentinel lymph node biopsy and is it recommended for pregnant women with breast cancer?
  2. What is the risk of fetal irradiation during a sentinel lymph node biopsy in pregnant women?
  3. Do sentinel lymph node biopsies impact the fetal or obstetrical prognosis in pregnant women with breast cancer?

Doctor’s Tip

A doctor might tell a patient considering sentinel lymph node biopsy during pregnancy that studies have shown the Tc99m injection used during the procedure exposes the fetus to a low level of radiation, well below the recommended threshold. The procedure does not seem to impact fetal or obstetrical prognosis, but it is important to discuss the risks and benefits on a case-by-case basis in multidisciplinary oncologic meetings. It is also advised to avoid using blue dye injection due to the theoretical risk of anaphylactic shock.

Suitable For

Patients who are typically recommended for sentinel lymph node biopsy include those with early-stage breast cancer, especially those with no clinically pathological lymph node involvement. This procedure may also be considered for pregnant women with breast cancer, as studies have shown that the risk of fetal irradiation from Tc99m injection is minimal and localized. However, further research and larger cohort studies are needed to confirm the safety and efficacy of sentinel lymph node biopsy in pregnant women. Ultimately, the decision to perform this procedure should be made on a case-by-case basis in multidisciplinary oncologic meetings.

Timeline

Before sentinel lymph node biopsy:

  1. Patient presents with early-stage breast tumor without clinically pathological lymph node involvement.
  2. Patient undergoes discussions with healthcare team to determine the need for SLN biopsy.
  3. Risks and benefits of SLN biopsy are explained to the patient, including the potential exposure of the fetus to radiation.
  4. Decision is made to proceed with SLN biopsy using Tc99m injection for lymphoscintigraphy.

After sentinel lymph node biopsy:

  1. Tc99m injection is administered at a conventional dose to localize the SLN.
  2. Lymphoscintigraphy scans are performed to visualize the injection site and SLN.
  3. SLN biopsy is performed, and the SLN is examined for the presence of cancer cells.
  4. Results of the SLN biopsy are discussed with the patient to determine further treatment options.
  5. Continued monitoring of the patient’s health and pregnancy status is conducted to ensure the well-being of both the patient and the fetus.

What to Ask Your Doctor

  1. What is a sentinel lymph node biopsy and why is it recommended for me?
  2. What are the potential risks and complications associated with a sentinel lymph node biopsy during pregnancy?
  3. How will the radioactive tracer used in the biopsy affect my fetus?
  4. Are there alternative options to a sentinel lymph node biopsy that may be safer for me and my baby?
  5. How will the results of the biopsy impact my treatment plan during pregnancy?
  6. What is the likelihood that the biopsy will affect my ability to carry the pregnancy to full term?
  7. Will I need additional monitoring or precautions after the biopsy due to my pregnancy?
  8. How will the biopsy affect my ability to breastfeed after giving birth?
  9. Are there any specific considerations or precautions I should take before or after the biopsy due to my pregnancy?
  10. Can you provide me with information or resources to help me better understand the procedure and its potential impact on my pregnancy?

Reference

Authors: Balaya V, Bonsang-Kitzis H, Ngo C, Delomenie M, Gosset M, Mimouni M, Nos C, David PM, Bats AS, Lecuru F. Journal: J Gynecol Obstet Hum Reprod. 2018 May;47(5):205-207. doi: 10.1016/j.jogoh.2018.03.003. Epub 2018 Mar 3. PMID: 29510266