***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background We sought to evaluate the utilization of blue dye in addition to radioisotope and its relative contribution to sentinel lymph node ( SLN ) mapping at a high-volume institution . Methods Using a prospect ively maintained data base , 3,402 breast cancer patients undergoing SLN mapping between 2002 and 2006 were identified . Trends in utilization of blue dye and results of SLN mapping were assessed through retrospective review . Statistical analysis was performed with Student t test and chi-square analysis . Results 2,049 ( 60.2 % ) patients underwent mapping with dual technique , and 1,353 ( 39.8 % ) with radioisotope only . Blue dye  use decreased gradually over time ( 69.8 % in 2002 to 48.3 % in 2006 , p < 0.0001 ) . Blue dye was used significantly more frequently in patients with lower axillary counts , higher body mass index ( BMI ) , African-American race , and higher T stage , and in patients not undergoing skin-sparing mastectomy . There was no difference in SLN identification rates between patients who had dual technique versus radiocolloid alone ( both 98.4 % ) . Four ( 0.8 % ) of 496 patients who had dual mapping and a positive SLN had a blue but not hot node as the only involved SLN . None of these four had significant counts detected in the axilla intraoperatively . Nine ( 0.4 % ) of 2,049 patients who had dual mapping had allergic reactions attributed to blue dye . Conclusions Blue dye use has decreased with increasing institutional experience with SLN mapping . In patients with adequate radioactive counts in the axilla , blue dye is unlikely to improve the success of sentinel node mapping PURPOSE To determine the detection rate , the false-negative rate , and the accuracy of sentinel lymph node ( SLN ) detection after neoadjuvant chemotherapy ( NAC ) for advanced breast cancer . PATIENTS AND METHODS A prospect i ve multicentric study was initiated to evaluate the results of  SLN biopsy with the combined method after NAC for advanced large operable breast cancer . RESULTS From September 2003 to March 2007 , 195 patients enrolled from 12 institutions were found suitable for evaluation . The detection rate was 90 % ( 176 of 195 patients ) , and the false-negative rate was 11.5 % ( six of 52 patients ) . Patients without axillary palpable nodes ( N0 ) before NAC had a better detection rate compared with patients with axillary suspicious nodes ( N1 , 94.6 % v 81.5 % ; P = .008 ) . The false-negative rate was not correlated with clinical nodal status before NAC ( 9.4 % v 15 % ; P = .66 ) . CONCLUSION This study confirms the feasibility of SLN biopsy after NAC in the case of large operable breast cancer . The detection rate , false-negative rate , and accuracy do not differ from those obtained in the case of early breast cancer without NAC , thus demonstrating the feasibility of SLN biopsy after NAC Background Sentinel lymph node ( SLN ) mapping with radioisotope and blue dye is rapidly becoming the st and ard of care for breast cancer . The optimal location for injection of radioisotope and blue dye is still being investigated . The goal of this study was to determine whether blue dye injection into the subareolar ( SA ) location localized the same sentinel nodes as the peritumoral ( PT ) location for patients with breast cancer . Methods Three hundred thirty-two patients with biopsy-proven operable breast cancer or ductal carcinoma in situ at two institutions underwent SLN mapping . Eighty-three patients had PT injection of blue dye  ( group 1 ) , and 249 patients had SA injection of blue dye ( group 2 ) . All patients underwent PT injection of99mTc-labeled sulfur colloid . Results The two groups were similar in age , previous biopsy type , and tumor size , location , and histology . The mean number of SLNs identified was 2.4 ( range , 0–9 ) in group 1 and 2.5 ( range , 0–11 ) in group 2 . The SLN identification rate was 95 % for group 1 and 97 % for group 2 . The isotope success rate was 94 % for both groups . The blue dye success rate was 84 % for group 1 and 90 % for group 2 . The isotope/blue dye concordance rate was 87 % for group 1 and 90 % for group 2 . At a median follow-up of 28 months ( range , 14 to 40 ) , there were no axillary recurrences in any of the 332 patients . Conclusions These data suggest that delivery of mapping reagents in the SA and PT locations identifies similar lymph nodes . Because of simplicity and the similarity in node identification between SA and PT injection , further investigation of the SA site for delivery of SLN mapping reagents for breast cancer is warranted Purpose To provide current recommendations on the use of sentinel node biopsy ( SNB ) for patients with early-stage breast cancer . Methods PubMed and the Cochrane Library were search ed for r and omized controlled trials , systematic review s , meta-analyses , and clinical practice guidelines from 2012 through July 2016 . An Up date Panel review ed the identified abstract s. Results Of the eight publications identified and review ed , none prompted a change in the 2014 recommendations , which are reaffirmed by the up date d literature review . Conclusion Women without sentinel lymph node ( SLN ) metastases should not receive axillary lymph node dissection ( ALND ) . Women with one to two metastatic SLNs who are planning to undergo breast-conserving surgery with whole-breast radiotherapy should not undergo ALND ( in most cases ) . Women with SLN metastases who will undergo mastectomy should be offered ALND . These three recommendations are based on r and omized controlled trials . Women with operable breast cancer and multicentric tumors , with ductal carcinoma in situ , who will undergo mastectomy , who previously underwent breast and /or axillary surgery , or who received preoperative/neoadjuvant systemic therapy may be offered SNB .  Women who have large or locally advanced invasive breast cancer ( tumor size T3/T4 ) , inflammatory breast cancer , or ductal carcinoma in situ ( when breast-conserving surgery is planned ) or are pregnant should not undergo SNB PURPOSE To develop a guideline for the use of sentinel node biopsy ( SNB ) in early stage breast cancer . METHODS An American Society of Clinical Oncology ( ASCO ) Expert Panel conducted a systematic review of the literature available through February 2004 on the use of SNB in early-stage breast cancer . The panel developed a guideline for clinicians and patients regarding the appropriate use of a sentinel lymph node identification and sampling procedure from hereon referred to as SNB . The guideline was review ed by selected experts in the field and the ASCO Health Services Committee and was approved by the ASCO Board of Directors . RESULTS The literature review identified one published prospect i ve r and omized controlled trial in which SNB was compared with axillary lymph node dissection ( ALND ) , four limited meta-analyses , and 69 published single-institution and multicenter trials in which the test performance of SNB was evaluated with respect to the results of ALND ( completion axillary dissection ) . There are currently no data on the effect of SLN biopsy on long-term survival of patients with breast cancer . However , a review of the available evidence demonstrates that , when performed by experienced clinicians , SNB appears to be a safe and acceptably accurate method for identifying early-stage breast cancer without involvement of the axillary lymph nodes . CONCLUSION SNB is an appropriate initial alternative to routine staging ALND for patients with early-stage breast cancer with clinical ly negative axillary nodes . Completion ALND remains st and ard treatment for patients with axillary metastases identified on SNB . Appropriately identified patients with negative results of SNB , when done under the direction of an experienced surgeon , need not have completion ALND . Isolated cancer cells detected by pathologic examination of the SLN with use of specialized techniques are currently of unknown clinical significance . Although such specialized techniques are often used , they are not a required part of SLN evaluation for breast cancer at this time . Data suggest that SNB is associated with less morbidity than ALND , but the comparative effects of these two approaches on tumor recurrence or patient survival are unknown The combination of preoperative lymphatic mapping with intra-operative probe detection is becoming the st and ard procedure for identifying tumour lymphatic spread at the time of initial treatment in breast cancer . There are a number of identification techniques for sentinel lymph nodes , but the concordance of the results of a sentinel lymph node biopsy with axillary lymph node dissection did not vary significantly among them . Periareolar ( p.a . ) injection of tracer is a new procedure specifically studied to overcome some limitations of other techniques ; in two groups of patients with early breast cancer we compared the periareolar with the subdermal technique . One hundred and fifty biopsy proven breast cancer patients were consecutively enrolled in this study . This population was divided into two groups : ( 1 ) group A , including 100 cancers ;  lymphatic mapping was performed by s.d . injection of both blue dye and radiotracer ; and ( 2 ) group B , including 50 cancers ;  lymphatic mapping was performed with a combination of blue dye injected p.a . and radiotracer injected s.d . For group A , with both techniques we identified one or more SLNs in 100/100 tumours ; blue dye detected the SLNs in 99/100 cancers ( 99 % ) , lymphoscintigraphy in 93/100 cancers ( 93 % ) . The concordance rate was 92 % . For group B , with both techniques we identified one or more SLNs in 49/50 cancers ( 98 % ) ; blue dye detected the SLNs in 48/50 , lymphoscintigraphy in 46/50 cancers ( 92 % ) . The concordance rate was 92 % . In the present study p.a . and s.d . injection of blue dye give similar and comparable results . The periareolar technique is simpler and has several advantages over the subdermal technique BACKGROUND The optimum timing of sentinel-lymph-node biopsy for breast cancer patients treated with neoadjuvant chemotherapy  is uncertain . The SENTINA ( SENTinel NeoAdjuvant ) study was design ed to evaluate a specific algorithm for timing of a st and ardised sentinel-lymph-node biopsy procedure in patients who undergo neoadjuvant chemotherapy .  METHODS SENTINA is a four-arm , prospect i ve , multicentre cohort study undertaken at 103 institutions in Germany and Austria . Women with breast cancer who were scheduled for neoadjuvant chemotherapy were enrolled into the study . Patients with clinical ly node-negative disease ( cN0 ) underwent sentinel-lymph-node biopsy before neoadjuvant chemotherapy ( arm A ) . If the sentinel node was positive ( pN1 ) , a second sentinel-lymph-node biopsy procedure was done after neoadjuvant chemotherapy ( arm B ) . Women with clinical ly node-positive disease ( cN+ ) received neoadjuvant chemotherapy . Those who converted to clinical ly node-negative disease after chemotherapy ( ycN0 ; arm C ) were treated with sentinel-lymph-node biopsy and axillary dissection . Only patients whose clinical nodal status remained positive ( ycN1 ) underwent axillary dissection without sentinel-lymph-node biopsy ( arm D ) . The primary endpoint was accuracy ( false-negative rate ) of sentinel-lymph-node biopsy after neoadjuvant chemotherapy  for patients who converted from cN1 to ycN0 disease during neoadjuvant chemotherapy ( arm C ) . Secondary endpoints included comparison of the detection rate of sentinel-lymph-node biopsy before and after neoadjuvant chemotherapy  , and also the false-negative rate and detection rate of sentinel-lymph-node biopsy after removal of the sentinel lymph node . Analyses were done according to treatment received ( per protocol ) . FINDINGS Of 1737 patients who received treatment , 1022 women underwent sentinel-lymph-node biopsy before neoadjuvant chemotherapy ( arms A and B ) , with a detection rate of 99.1 % ( 95 % CI 98.3 - 99.6 ; 1013 of 1022 ) . In patients who converted after neoadjuvant chemotherapy from cN+ to ycN0 ( arm C ) , the detection rate was 80.1 % ( 95 % CI 76.6 - 83.2 ; 474 of 592 ) and false-negative rate was 14.2 % ( 95 % CI 9.9 - 19.4 ; 32 of 226 ) . The false-negative rate was 24.3 % ( 17 of 70 ) for women who had one node removed and 18.5 % ( 10 of 54 ) for those who had two sentinel nodes removed ( arm C ) . In patients who had a second sentinel-lymph-node biopsy procedure after neoadjuvant chemotherapy ( arm B ) , the detection rate was 60.8 % ( 95 % CI 55.6 - 65.9 ; 219 of 360 ) and the false-negative rate was 51.6 % ( 95 % CI 38.7 - 64.2 ; 33 of 64 ) . IN 
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Conclusions Although the combination of blue dye and radioisotope outperformed radioisotope alone in SLN detection , the superiority for dual tracers may be limited for patients with positive lymphoscintigraphy or for those after neoadjuvant chemotherapy .
Besides , the combined modality did not help lower the false-negative rate