It is safe and effective to check for the spread of early breast cancer in pregnant women using sentinel node biopsy rather than completely dissecting the node, researchers from the International Network of Cancer, Infertility and Pregnancy and the German Breast Group have shown in a study presented at ESMO 2014 in Madrid.

Sentinel lymph node biopsies have been the topic of intensive research over the last 2 decades, and have replaced the older and more invasive method of axillary lymph node dissection for women patients without clinically suspicious axillary lymph nodes.

This method removes the first (or ‘sentinel’) lymph node receiving lymphatic drainage from the tumour, therefore most likely to contain metastatic cells.

If the SLN does not contain metastatic disease, the remainder of the lymph nodes do not have to be removed, thereby sparing the patient the associated side-effects such as lymphedema and reduced movement.

The latest guidelines for doctors still advise that they perform axillary lymph node dissection and avoid sentinel lymph node biopsy during pregnancy, due to lack of safety data, explains Sileny Han of University Hospitals Leuven, Belgium, who is presenting the results of a new study at ESMO 2014.

“We aim to add to the body of evidence that sentinel node biopsy is feasible during pregnancy and should be considered an option.”

This study is the largest series to date to assess this question.

The researchers studied 97 women with breast cancer who underwent sentinel node biopsy.

Their aim was to assess whether the sentinel lymph node procedure is safe from an oncologic point of view for the mother.

After a median follow-up of 35 months, eight patients had experienced a loco-regional relapse, meaning their cancer recurred in the same or other breast, the chest wall, including two who developed tumours in their lymph nodes.

Four patients developed distant metastases, of whom three died of breast cancer.

These results show that sentinel lymph node biopsy during pregnancy has a low axillary recurrence rate, they write.

“This staging method can be considered during pregnancy instead of standard axillary lymph node dissection for early stage, clinically node negative breast cancer”.

Adds Peccatori, co-author on this study: “Axillary staging in early breast cancer is a changing paradigm. Data from different institutions in Europe and US have demonstrated that in non-pregnant patients, sentinel node biopsy is an effective staging procedure that holds equivalent results to axillary lymph node dissection even in patients with up to three positive sentinel nodes, if post operative systemic treatment is adequate. Furthermore, hand sentinel node biopsy is associated with improved arm motility, decreased armpit pain and numbness and shorter hospital stay. Why should we deny this procedure to pregnant breast cancer patients?”

Source: ESMO