• Judy C Boughey, Vera J Suman, Elizabeth A Mittendorf, Gretchen M Ahrendt, Lee G Wilke, Bret Taback, A Marilyn Leitch, Teresa S Flippo-Morton, Henry M Kuerer, Monet Bowling, Kelly K Hunt, and Alliance for Clinical Trials in Oncology.
• *Mayo Clinic, Rochester, MN †Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN ‡MD Anderson Cancer Center, Houston, TX §University of Pittsburgh, Pittsburgh, PA ¶University of Wisconsin, Madison, WI ‖Columbia University Medical Center, New York, NY **University of Texas Southwestern Medical Center, Dallas, TX ††Carolinas Medical Center, Charlotte, NC; and ‡‡Indiana University Medical Center, Indianapolis, IN.
• Ann. Surg. 2015 Mar 1; 261 (3): 547-52.

ObjectiveTo evaluate factors affecting sentinel lymph node (SLN) identification after neoadjuvant chemotherapy (NAC) in patients with initial node-positive breast cancer.BackgroundSLN surgery is increasingly used for nodal staging after NAC and optimal technique for SLN identification is important.MethodsThe 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.ResultsOf 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.ConclusionsThe SLN identification rate after NAC was higher when mapping was performed using radiolabeled colloid alone or with blue dye compared with blue dye alone. Optimal tracer use is important to ensure successful identification of SLN(s) after NAC.

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