Abstract
Objective: To evaluate factors affecting sentinel lymph node (SLN) identification after neoadjuvant chemotherapy (NAC) in patients with initial nodepositive breast cancer. Background: SLN surgery is increasingly used for nodal staging after NAC and optimal technique for SLN identification is important. Methods: The American College of Surgeons Oncology Group Z1071 prospective trial enrolled clinical T0-4, N1-2, M0 breast cancer patients. After NAC, SLN surgery and axillary lymph node dissection (ALND) were planned. Multivariate logistic regression modeling assessing factors influencing SLN identification was performed. Results: Of 756 patients enrolled, 34 women withdrew, 21 were ineligible, 12 underwent ALND only, and 689 had SLN surgery attempted. At least 1 SLN was identified in 639 patients (92.7%: 95% CI: 90.5%-94.6%). Among factors evaluated, mapping technique was the only factor found to impact SLN identification; with use of blue dye alone increasing the likelihood of failure to identify the SLN relative to using radiolabeled colloid +/- blue dye (P = 0.006; OR = 3.82; 95% CI: 1.47-9.92). The SLN identification rate was 78.6% with blue dye alone; 91.4% with radiolabeled colloid and 93.8% with dual mapping agents. Patient factors (age, body mass index), tumor factors (clinical T or N stage), pathologic nodal response to chemotherapy, site of tracer injection, and length of chemotherapy treatment did not significantly affect the SLN identification rate. Conclusions: The SLN identification rate after NAC was higher when mapping was performed using radiolabeled colloid alone or with blue dye com- pared with blue dye alone. Optimal tracer use is important to ensure successful identification of SLN(s) after NAC.
Original language | English (US) |
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Pages (from-to) | 547-552 |
Number of pages | 6 |
Journal | Annals of surgery |
Volume | 261 |
Issue number | 3 |
DOIs | |
State | Published - 2015 |
Keywords
- Breast cancer
- Identification rate
- Neoadjuvant chemotherapy
- Sentinel node
ASJC Scopus subject areas
- Surgery