Safety of sentinel node biopsy in pregnant patients with breast cancer

Background: Lymphoscintigraphy (LS) and sentinel lymph node biopsy (SLNB) have typically been contraindicated for pregnant patients diagnosed with breast cancer because they are considered unsafe. Patients and methods: Twenty-six premenopausal non-pregnant patients who were candidates for LS underwent peritumoral injection of similar to 12 MBq of Tc-99m-HSA nanocolloids. Static [ 15 min and 16h post-injection (p.i.)] and whole-body (16h p.i.) scintigraphic images were acquired. Activity concentration in the urine (0-2, 2-4, 4-8, 8-16 h p.i.) was evaluated by a gamma-counter. Activity in the bloodstream was measured at 4 and 16h p.i. Thermoluminescent dosimeters (TLD) were placed, before tracer injection, on the injection site, between injection site and epigastrium (two points), and on the epigastrium, umbilicus and hypogastrium, and were removed before surgery. Results: Scintigraphic images showed no radiotracer concentration except in the injection site and in the sentinel node. In all patients, the total activity excreted within the first 16h was <2% of the injected activity. Activity in the blood pool was, at each time point, <1% of the injected activity. In 23 of 26 patients, all absorbed dose measurements were lower than the sensitivity of the TLD (<10 mu Gy); in the remaining three patients, the absorbed doses at the level of epigastrium, umbilicus and hypogastrium were in the following ranges: 40-320, 120-250 and 30-140 mu Gy, respectively. Conclusions: According to our standard technique (12MBq of Tc-99m-HAS), LS and SLNB can be performed safely during pregnancy, since the very low prenatal doses from this diagnostic procedure, when properly performed, do not significantly increase the risk of prenatal death, malformation or mental impairment.