Factors affecting sentinel lymph node identification rate after neoadjuvant chemotherapy for breast cancer patients enrolled in ACOSOG Z1071 (alliance)

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

Research output: Contribution to journalArticle

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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 languageEnglish
Pages (from-to)547-552
Number of pages6
JournalAnnals of Surgery
Volume261
Issue number3
DOIs
StatePublished - 2015

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Breast Neoplasms
Drug Therapy
Coloring Agents
Colloids
Lymph Node Excision
Sentinel Lymph Node
Age Factors
Body Mass Index
Logistic Models
Clinical Trials
Injections

Keywords

  • Breast cancer
  • Identification rate
  • Neoadjuvant chemotherapy
  • Sentinel node

ASJC Scopus subject areas

  • Surgery

Cite this

Factors affecting sentinel lymph node identification rate after neoadjuvant chemotherapy for breast cancer patients enrolled in ACOSOG Z1071 (alliance). / Boughey, Judy C.; Suman, Vera J.; Mittendorf, Elizabeth A.; Ahrendt, Gretchen M.; Wilke, Lee G.; Taback, Bret; Leitch, A. Marilyn; Flippo-Morton, Teresa S.; Kuerer, Henry M.; Bowling, Monet; Hunt, Kelly K.

In: Annals of Surgery, Vol. 261, No. 3, 2015, p. 547-552.

Research output: Contribution to journalArticle

Boughey, JC, Suman, VJ, Mittendorf, EA, Ahrendt, GM, Wilke, LG, Taback, B, Leitch, AM, Flippo-Morton, TS, Kuerer, HM, Bowling, M & Hunt, KK 2015, 'Factors affecting sentinel lymph node identification rate after neoadjuvant chemotherapy for breast cancer patients enrolled in ACOSOG Z1071 (alliance)', Annals of Surgery, vol. 261, no. 3, pp. 547-552. https://doi.org/10.1097/SLA.0000000000000551
Boughey, Judy C. ; Suman, Vera J. ; Mittendorf, Elizabeth A. ; Ahrendt, Gretchen M. ; Wilke, Lee G. ; Taback, Bret ; Leitch, A. Marilyn ; Flippo-Morton, Teresa S. ; Kuerer, Henry M. ; Bowling, Monet ; Hunt, Kelly K. / Factors affecting sentinel lymph node identification rate after neoadjuvant chemotherapy for breast cancer patients enrolled in ACOSOG Z1071 (alliance). In: Annals of Surgery. 2015 ; Vol. 261, No. 3. pp. 547-552.
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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.",
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AU - Boughey, Judy C.

AU - Suman, Vera J.

AU - Mittendorf, Elizabeth A.

AU - Ahrendt, Gretchen M.

AU - Wilke, Lee G.

AU - Taback, Bret

AU - Leitch, A. Marilyn

AU - Flippo-Morton, Teresa S.

AU - Kuerer, Henry M.

AU - Bowling, Monet

AU - Hunt, Kelly K.

PY - 2015

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N2 - 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.

AB - 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.

KW - Breast cancer

KW - Identification rate

KW - Neoadjuvant chemotherapy

KW - Sentinel node

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