S N Han1,2, F Amant3,4,5, E H Cardonick6,2, S Loibl7,2, F A Peccatori8,2, O Gheysens9,2, C A Sangalli7,2, V Nekljudova7,2, K Dahl Steffensen10,2, M Mhallem Gziri11,2, C P Schröder12,2, C A R Lok13,2, A Verest1,2, P Neven1,2, A Smeets1,2, G Pruneri14,2, M Cremonesi15,2, O Gentilini16,2. 1. Department of Oncology, Multidisciplinary Breast Centre, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Louvain, Belgium. 2. Breast Unit, San Raffaele Scientific and Research Hospital, Milan, Italy. 3. Department of Oncology, Multidisciplinary Breast Centre, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Louvain, Belgium. frederic.amant@uzleuven.be. 4. Department of Gynecologic Oncology, Center for Gynecologic Oncology Amsterdam, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands. frederic.amant@uzleuven.be. 5. Breast Unit, San Raffaele Scientific and Research Hospital, Milan, Italy. frederic.amant@uzleuven.be. 6. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cooper Medical School at Rowan University, Camden, NJ, USA. 7. German Breast Group, Neu-Isenburg, Germany. 8. Gynecologic Oncology Division, Fertility and Procreation Unit, European Institute of Oncology, Milan, Italy. 9. Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, University Hospitals Leuven, KU Leuven, Louvain, Belgium. 10. Department of Clinical Oncology, Vejle Hospital, Vejle, Denmark. 11. Department of Obstetrics, Cliniques Universitaires St. Luc, Brussels, Belgium. 12. Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 13. Department of Gynecologic Oncology, Center for Gynecologic Oncology Amsterdam, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands. 14. Department of Pathology, Biobank for Translational Medicine Unit, European Institute of Oncology, Milan, Italy. 15. Radiation Research Unit, European Institute of Oncology, Milan, Italy. 16. Division of Breast Surgery, European Institute of Oncology, Milan, Italy.
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.
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.
Entities:
Keywords:
Breast cancer; Lymphoscintigraphy; Pregnancy; Sentinel lymph node
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