All of the following are true about accelerated partial breast irradiation (APBI) EXCEPT:
Accelerated partial breast irradiation (APBI) is delivered in an abbreviated fashion (twice daily for 5 days) and at a lower total dose compared with the standard course of 5 to 6 weeks of radiation (50 Gray with or without a boost) in the case of whole breast irradiation. The ASTRO guidelines describe patients "suitable" for APBI to include women older than 60 years with a unifocal, Tl, ER-positive tumor with no lymphovascular invasion, and margins of at least 2 mm. Finally, a group felt to be "unsuitable" for APBI includes those with T3 or T4 disease, ER-negative disease, multifocality, multicentricity, extensive lymphovascular invasion (LVI), or positive margins.
Patients not suitable for sentinel lymph node (SLN) biopsy include all of the following EXCEPT:
Clinical situations where sentinel lymph node (SLN) dissection is not recommended include patients with inflammatory breast cancers, those with palpable axillary lymphadenopathy and biopsy-proven metastasis, DCIS without mastectomy, or prior axillary surgery. Although limited data are available, SLN dissection appears to be safe in pregnancy when performed with radioisotope alone.
Which of the following is true concerning breast cancer during pregnancy?
Breast cancer occurs in 1 of every 3000 pregnant women, and axillary lymph node metastases are present in up to 75% of these women. Fewer than 25% of the breast nodules developing during pregnancy and lactation will be cancerous. Mammography is rarely indicated because of its decreased sensitivity during pregnancy and lactation; however, the fetus can be shielded if mammography is needed. Chemotherapy administered during the first trimester carries a risk of spontaneous abortion and a 12% risk of birth defects. There is no evidence of teratogenicity resulting from administration of chemotherapeutic agents in the second and third trimesters.
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