title: Safety of radioactive sentinel node biopsy for breast cancer and the pregnant surgeon - A review.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Breast Surgery, Broomfield Hospital, Chelmsford, Essex, CM1 7ET, United Kingdom. Electronic address: sahasunita@hotmail.com.
authors.forename: Sunita
authors.initials: S
authors.lastname: Saha
authors.affiliation: Department of Breast Surgery, Broomfield Hospital, Chelmsford, Essex, CM1 7ET, United Kingdom.
authors.forename: Rosamond
authors.initials: R
authors.lastname: Jacklin
authors.affiliation: Department of Breast Surgery, Broomfield Hospital, Chelmsford, Essex, CM1 7ET, United Kingdom.
authors.forename: Arifa
authors.initials: A
authors.lastname: Siddika
authors.affiliation: Department of Breast Surgery, Broomfield Hospital, Chelmsford, Essex, CM1 7ET, United Kingdom.
authors.forename: Gill
authors.initials: G
authors.lastname: Clayton
authors.affiliation: Department of Breast Surgery, Broomfield Hospital, Chelmsford, Essex, CM1 7ET, United Kingdom.
authors.forename: Sascha
authors.initials: S
authors.lastname: Dua
authors.affiliation: Department of Breast Surgery, Broomfield Hospital, Chelmsford, Essex, CM1 7ET, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Smith
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D016273:Occupational Exposure; D011247:Pregnancy; D011835:Radiation Protection; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects*; D066231:Surgeons
keywords: Breast cancer; Occupational radiation exposure; Pregnancy risk radiation; Sentinel node biopsy