Sentinel Lymph Node Biopsy in Pregnant Breast Cancer Patients: A Literature Review
https://doi.org/10.18027/2224-5057-2025-051
Abstract
This literature review analyzes current approaches to the management of pregnant patients with breast cancer (BC) using sentinel lymph node biopsy (SLNB). SLNB represents a safe alternative to axillary lymph node dissection (ALND) in clinically node-negative patients, significantly reducing adverse surgical sequelae such as lymphedema and restricted mobility. The review presents the latest data on the use of radionuclide lymph node mapping with 99mTc (in doses ≤ 10 MBq). Data confirming the safety of the procedure for the fetus, including the absence of an increased risk of congenital anomalies or pregnancy complications, are provided. The method, besides being safe, is comparable in effectiveness and outcomes to the non-pregnant patient group. The review discusses current clinical guidelines for treating pregnant patients, which generally support the use of this approach, recommending an individualized strategy. Multidisciplinary management involving oncologists, surgeons, and obstetrician-gynecologists is critically important to balance maternal treatment efficacy with fetal safety. Articles investigating the safety and efficacy of SLNB in pregnant patients were selected for inclusion in this review using the MEDLINE, UpToDate, Web of Science, and Scopus databases.
About the Authors
A. A. Parokonnaya
N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
Russian Federation
Competing Interests:
Russian Federation
Anastasiya Anatolevna Parokonnaya
23 Kashirskoe Shosse, Moscow 115478
Competing Interests:
The authors declare that there are no possible conflicts of interest.
A. S. Krylov
N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
Russian Federation
Competing Interests:
Russian Federation
Krylov Alexander Sergeevich
23 Kashirskoe Shosse, Moscow 115478
Competing Interests:
The authors declare that there are no possible conflicts of interest.
R. G. Shmakov
Moscow Regional Research Institute of Obstetrics and Gynecology named after Academician V. I. Krasnopolsky
Russian Federation
Competing Interests:
Russian Federation
Shmakov Roman Georgievich
22a Pokrovka St., Moscow 101000
Competing Interests:
The authors declare that there are no possible conflicts of interest.
A. V. Petrovskii
N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
Russian Federation
Competing Interests:
Russian Federation
Petrovsky Alexander Valerievich
23 Kashirskoe Shosse, Moscow 115478
Competing Interests:
The authors declare that there are no possible conflicts of interest.
References
1. Matikas A., Bergh J. Breast cancer during pregnancy-The oncologist’s point of view. Acta Obstet Gynecol Scand 2024;103(4):775-778. https://doi.org/10.llll/aogs.14729
2. Boere I., Lok C., Poortmans P., et al. Breast cancer during pregnancy: epidemiology, phenotypes, presentation during pregnancy and therapeutic modalities. Best Pract Res Clin Obstet Gynaecol 2022;82:46-59. https://doi.org/10.1016/j.bpobgyn.2022.05.001
3. Paluch-Shimon S., Cardoso F., Partridge A.H., et al. ESMO clinical practice guidelines for the management of patients with breast cancer during pregnancy. Ann Oncol 2020;31(12):1624-1635. https://doi.Org/10.1016/j.annonc.2020.03.284
4. Halstead W.S. The Results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from june, 1889, to january, 1894. Ann Surg 1894;20(5):497-506. https://doi.org/10.1097/00000658-189407000-00075
5. Veronesi U., Paganelli G., Viale G., et al. Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of arandomised controlled study. Lancet Oncol 2006;7(12):983-90. https://doi.org/10.1016/S1470-2045(06)70947-0
6. Giuliano A.E., Kirgan D.M., Guenther J.M., Morton D.L. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 1994;220(3):391-8; discussion 398-401. https://doi.org/10.1097/00000658-199409000-00015
7. Azim H.A. Jr, Santoro L., Russell-Edu W., et al. Prognosis of pregnancy-associated breast cancer: a meta-analysis of 30 studies. Cancer Treat Rev 2012;38(7):834-42. https://doi.Org/10.1016/j.ctrv.2012.06.004
8. Mondi M.M., Cuenca R.E., Ollila D.W., et al. Sentinel lymph node biopsy during pregnancy: initial clinical experience. Ann Surg Oncol 2007;14(l):218-221. https://doi.org/10.1245/sl0434-006-9199-l
9. 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 2018;168(2):551-557. https://doi.org/10.1007/sl0549-017-4611-z
10. Gentilini O., Cremonesi M., Trifiro G., et al. Safety of sentinel node biopsy in pregnant patients with breast cancer. Ann Oncol 2004;15(9):1348-1351. https://doi.org/10.1093/annonc/mdh355
11. Gentilini O., Cremonesi M., Toesca A., et al. Sentinel lymph node biopsy in pregnant patients with breast cancer. Eur J Nucl Med Mol Imaging 2010;37(l):78-83. https://doi.org/10.1007/s00259-009-1217-7
12. Khera S.Y., KilukJ.V., Hasson D.M., et al. Pregnancy-associated breast cancer patients can safely undergo lymphatic mapping. BreastJ 2008;14(3):250-254. https://doi.Org/10.llll/j.1524-4741.2008.00570
13. Bezu C., Coutant C., Salengro A., et al. Anaphylactic response to blue dye during sentinel lymph node biopsy. Surg Oncol 2011;20(l):e55-9. https://doi.Org/10.1016/j.suronc.2010.10.002
14. Martfn-Lazaro J., Nunez-Orjales R., Battikhi-Precedo N., et al. Allergy to Blue Dye. J Envestig Allergol Clin Immunol 2016;26(6):381-383. https://doi.org/10.18176/jiaci.0101
15. Balaya V., Bonsang-Kitzis H., Ngo C., et al. What about sentinel lymph node biopsy for early breast cancer during pregnancy? J Gynecol Obstet Hum Reprod 2018;47(5):205-207. https://doi.Org/10.1016/j.jogoh.2018.03.003
16. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 2007;37(2-4):l-332. https://doi.Org/10.1016/j.icrp.2007.10.003
17. Keleher A., Wendt R. 3rd, Delpassand E., et al. The safety of lymphatic mapping in pregnant breast cancer patients using Tc-99m sulfur colloid. BreastJ 2004;10(6):492-5. https://doi.Org/10.llll/j.1075-122X.2004.21503.x
18. Pandit-Taskar N., Dauer L.T., Montgomery L., et al. Organ and fetal absorbed dose estimates from "mTc-sulfur colloid lymphoscintigraphy and sentinel node localization in breast cancer patients. J Nucl Med 2006;47:1202-1208.
19. Spanheimer PM, Graham MM, Sugg SL, Scott-Conner CE, Weigel RJ. Measurement of uterine radiation exposure from lymphoscintigraphy indicates safety of sentinel lymph node biopsy during pregnancy. Ann Surg Oncol. 2009 May;16(5):1143-7. doi:10.1245/sl0434-009-0390-z. Epub 2009 Mar 7. PMID: 19267158.
20. Cropper AB, Calvillo KZ, Dominici L, Troyan S, Rhei E, Economy KE, Tung NM, Schapira L, Meisel JL, Partridge AH, Mayer EL. Sentinel lymph node biopsy in pregnant women with breast cancer. Ann Surg Oncol. 2014 Aug;2l(8):2506-ll. doi:10.1245/sl0434-014-3718-2. Epub 2014 Apr 23. PMID: 24756813
21. Krylov A.S., Narkevich B.Ya., Ryzhkov A.D., et al. Evaluation of the radiation dose of an embryo/fetus during lymphoscintigraphy (sentinel lymph node mapping) in pregnant patients with breast cancer. J Oncol Diagn Radiol Ra-diotherapy2021;4(4):78-87 (In Russ.), https://doi.org/10.37174/2587-7593-2021-4-4-78-87
22. Loibl S., Azim H.A. Jr, Bachelot T., et al. ESMO Expert Consensus Statements on the management of breast cancer during pregnancy (PrBC). Ann Oncol 2023;34(10):849-866. https://doi.Org/10.1016/j.annonc.2023.08.001
23. Bothou A., Margioula-Siarkou C., Petousis S., et al. Sentinel lymph node biopsy for breast cancer during pregnancy: A comprehensive update. Eur J Clin Invest 2024;54(3):el4134. https://doi.org/10.llll/eci.14134
24. Pellini F., Bertoldi L., Deguidi G., et al. The use of indocyanine green as the only tracer for the identification of the sentinel lymph node in breast cancer: safety and feasibility. Gland Surg 2022;ll(7):1139-1147. https://doi.org/10.21037/gs-21-609
25. Abe H., Mori T., Umeda T., et al. Indocyanine green fluorescence imaging system for sentinel lymph node biopsies in early breast cancer patients. Surg Today 2011;41(2):197-202. https://doi.org/10.1007/s00595-010-4440-8
26. Guo J., Yang H., Wang S., et al. Comparison of sentinel lymph node biopsy guided by indocyanine green, blue dye, and their combination in breast cancer patients: a prospective cohort study. World J Surg Oncol 2017;15(l):196. https://doi.org/10.1186/sl2957-017-1264-7
27. Lee S., Kim E.Y., Kang S.H., et al. Sentinel node identification rate, but not accuracy, is significantly decreased after pre-operative chemotherapy in axillary node-positive breast cancer patients. Breast Cancer Res Treat 2007;102(3):283— 288. https://doi.org/10.1007/sl0549-006-9330-9
28. White K.P., Sinagra D., Dip F., et al. Indocyanine green fluorescence versus blue dye, technetium-99M, and the dual-marker combination of technetium-99M + blue dye for sentinel lymph node detection in early breast cancer—meta-analysis including consistency analysis. Surgery 2024;175(4):963—973. https://doi.Org/10.1016/j.surg.2023.10.021
29. Lyman G.H., Giuliano A.E., Somerfield M.R., et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 2005;23(30):7703-7720. https://doi.org/10.1200/JC0.2005.08.001
30. NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. Version 1.2014
31. NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. Version 3.2024
32. Filippakis GM, Zografos G. Contraindications of sentinel lymph node biopsy: are there any really? World J Surg Oncol 2007;5:10. https://doi.org/10.1186/1477-7819-5-10
33. Cardoso F., Loibl S., Pagani O., et al. The European Society of Breast Cancer Specialists recommendations for the management of young women with breast cancer. Eur J Cancer 2012;48(l8):3355-3377. https://doi.org/10.1016/j.ejca.2012.10.004
34. Peccatori F.A., Azim H.A., Orecchia R., et al. Cancer, pregnancy and fertility: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013;24(Suppl 6):vil60-vil70. https://doi.org/10.1093/annonc/mdtl99
35. Hadzikadic-Gusic L., Ceric T., Marijanovic I., et al. Guidelines for breast cancer management in Bosnia and Herzegovina. Biomol Biomed 2023;23(l):2-14. https://doi.org/10.17305/bjbms.2022.7504
36. Chen Q., Qiu Y., Zhang M., et al. Clinical practice guidelines for pregnancy-associated breast cancer: Chinese society of breast surgery (CSBrS) practice guidelines 2021. Chin Med J 2021;134(20):2395-2397. https://doi.org/10.1097/CM9.0000000000001686
37. Cubillo A., Morales S., Goni E., et al. Multidisciplinary consensus on cancer management during pregnancy. Clin Transl Oncol 2021;23(6):1054-1066. https://doi.org/10.1007/sl2094-020-02491-8
38. Associazione Italiana di Oncologia Medica (AIOM). Linee Guida AIOM: Neoplasie della Mammella, 2023. Available at: https://www.aiom.it/linee-guida-aiom/
39. Mueller, V., Loibl, S., Han, S.N., et al. AGO Recommendations for Breast Cancer in Pregnancy, 2023.
Review
For citations:
Parokonnaya A.A., Krylov A.S., Shmakov R.G., Petrovskii A.V. Sentinel Lymph Node Biopsy in Pregnant Breast Cancer Patients: A Literature Review. Malignant tumours. 2025;15(3):53-60. (In Russ.) https://doi.org/10.18027/2224-5057-2025-051
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