Safety of radioactive sentinel node biopsy for breast cancer and the pregnant surgeon - A review

Abstract

Introduction: Sentinel node biopsy is an established key element in the surgical management of breast cancer and melanoma. Several studies have assessed radiation exposure during sentinel node biopsy and confirmed it to be safe for health workers. Recent demographic changes amongst surgeons has resulted in increasing numbers of women of childbearing age performing sentinel node procedures as a regular part of their surgical practice. We aimed to assess the radiation risk posed by sentinel node biopsy in breast cancer surgery to pregnant surgeons.

Methods: A search of indexed citations from PUBMED and Cochrane databases for studies assessing the radiation exposure to the primary surgeon during sentinel node biopsy was undertaken. Due to the variability of melanoma location in relation to nodal basins, we have focused on sentinel node biopsy for breast cancer where surgeon positioning, radiopharmaceutical injection and nodal dissection sites are consistent.

Results: From the eleven studies totalling 344 procedures, exposure doses to the abdomens and fingers of surgeons undertaking sentinel node biopsy were within the guideline maximum recommended exposure limit of 1 mSv as set out by the International Committee on Radiation Protection (ICRP) 107 recommendations as long as fewer than one hundred procedures are performed throughout the duration of the pregnancy. Of note the radiation doses in the newer studies were much lower and used more sensitive instruments to detect radiation exposure.

Conclusions: Providing the numbers of procedures are within defined limits, the radiation risks posed to pregnant surgeons undertaking sentinel node procedures are limited and within the regulatory guidelines for pregnancy.

Keywords: Breast cancer; Occupational radiation exposure; Pregnancy risk radiation; Sentinel node biopsy.