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

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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.

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Acknowledgements

This study was supported by Research Foundation-Flanders (Project G0358.06), Stichting tegen Kanker, and Belgian Cancer Plan (Ministry of Health).

Author information

Author notes

  1. S. N. Han, F. Amant, E. H. Cardonick, S. Loibl, F. A. Peccatori, O. Gheysens, C. A. Sangalli, V. Nekljudova, K. Dahl Steffensen, M. Mhallem Gziri, C. P. Schröder, C. A. R. Lok, A. Verest, P. Neven, A. Smeets, G. Pruneri, M. Cremonesi & O. Gentilini

    Present address: Breast Unit, San Raffaele Scientific and Research Hospital, Milan, Italy

Authors and Affiliations

  1. Department of Oncology, Multidisciplinary Breast Centre, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Louvain, Belgium

    S. N. Han, F. Amant, A. Verest, P. Neven & A. Smeets

  2. Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Cooper Medical School at Rowan University, Camden, NJ, USA

    E. H. Cardonick

  3. German Breast Group, Neu-Isenburg, Germany

    S. Loibl, C. A. Sangalli & V. Nekljudova

  4. Gynecologic Oncology Division, Fertility and Procreation Unit, European Institute of Oncology, Milan, Italy

    F. A. Peccatori

  5. Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, University Hospitals Leuven, KU Leuven, Louvain, Belgium

    O. Gheysens

  6. Department of Clinical Oncology, Vejle Hospital, Vejle, Denmark

    K. Dahl Steffensen

  7. Department of Obstetrics, Cliniques Universitaires St. Luc, Brussels, Belgium

    M. Mhallem Gziri

  8. Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    C. P. Schröder

  9. Department of Gynecologic Oncology, Center for Gynecologic Oncology Amsterdam, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands

    F. Amant & C. A. R. Lok

  10. Department of Pathology, Biobank for Translational Medicine Unit, European Institute of Oncology, Milan, Italy

    G. Pruneri

  11. Radiation Research Unit, European Institute of Oncology, Milan, Italy

    M. Cremonesi

  12. Division of Breast Surgery, European Institute of Oncology, Milan, Italy

    O. Gentilini

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  1. S. N. Han
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  2. F. Amant
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Consortia

On behalf of the International Network on Cancer, Infertility and Pregnancy

Corresponding author

Correspondence to F. Amant.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

S.N. Han and F. Amant contributed equally to this work.

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Han, S.N., Amant, F., Cardonick, E.H. et al. Axillary staging for breast cancer during pregnancy: feasibility and safety of sentinel lymph node biopsy. Breast Cancer Res Treat 168, 551–557 (2018). https://doi.org/10.1007/s10549-017-4611-z

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  • DOI: https://doi.org/10.1007/s10549-017-4611-z

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