Question: Is Patent Blue Dye safe in pregnant women for sentinel node biopsy? As far as I know it was avoided in the past in pregnant patients due to a risk for allergic reactions. What is the current practice?
Answer: Patent blue dye is usually not indicated for sentinel node detection during pregnancy for the risk of allergic reaction and for the lower yield and higher complexity compared to Tc based detection. We have recently engaged at European and US level breast surgeons involved in sentinel node detection during pregnancy and no issue were raised for the mother (detection rate is the same as in non pregnant women) or babies when Tc based detection was used. To me, this the remains the standard.
Question: Trastuzumab during pregnancy? My understanding, based on different papers published few years ago, was that is considered safe, but for a short period of time (no more than a trimester). What is your opinion - better not to use it at all?
Answer: Short courses of Trastuzumab used in the first trimester are not dangerous. We reported a case of ours few years ago and also H Azim Jr published data from the BIG studies. Most of the patients got pregnant while on Trastuzumab during adjuvant treatment with no side effects if stopped at pregnancy diagnosis. Issues arise when prolonged fetal exposure happens in the second and third trimester. In this situation, risks of oligo-anhydramnios and also fetal deaths are significant.