Localizing Positive Axillary Lymph Nodes in Breast Cancer Patients Post Neoadjuvant Therapy.

INTRODUCTION: Multiple trials demonstrated the feasibility of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy. Those trials reported > 10% false-negative rate; however, a subset analysis of the Z1071 trial demonstrated that removing the clipped positive lymph node (LN) during SLNB reduces the false-negative rate to 6.8% post neoadjuvant chemotherapy. This study examines the factors that might contribute to the ability to identify the clipped nodes post neoadjuvant therapy (NAT). MATERIALS AND METHODS: Breast cancer patients with biopsy-proven metastatic axillary LN who underwent NAT, converted to N0, had preoperative localization, and then SLNB between 2018 and 2020 at a single institution were identified. A retrospective chart review was performed. Demographic and preoperative variables were compared between localization and nonlocalization groups. RESULTS: Eighty patients who met inclusion criteria were included. A total of 39 patients were localized after NAT completion (49%). Only half of the patients with ultrasound-detectable marker clips were able to be localized. Minimal LN abnormality was seen in imaging after NAT completion in 39 patients and is significantly associated with localization; 26 (67%) were localized (Odds Ratio 4.31, P = 0.002, 95% Confidence Interval 1.69-10.98). CONCLUSIONS: Our study suggests that radiologically abnormal LNs on preoperative imaging after NAT completion are more likely to be localized. Nodes that ultimately normalize by imaging criteria remain a significant challenge to localize, and thus localization before starting NAT is suggested. A better technology is needed for LN localization after prolonged NAT for best accuracy and avoids repeated procedures.

Seebeck and Figure of Merit Enhancement by Rare Earth Doping in Yb14-xRExZnSb11 (x = 0.5).

Yb14ZnSb11 has been of interest for its intermediate valency and possible Kondo designation. It is one of the few transition metal compounds of the Ca14AlSb11 structure type that show metallic behavior. While the solid solution of Yb14Mn1-xZnxSb11 shows an improvement in the high temperature figure of merit of about 10% over Yb14MnSb11, there has been no investigation of optimization of the Zn containing phase. In an effort to expand the possible high temperature p-type thermoelectric materials with this structure type, the rare earth (RE) containing solid solution Yb14-xRExZnSb11 (RE = Y, La) was investigated. The substitution of a small amount of 3+ rare earth (RE) for Yb2+ was employed as a means of optimizing Yb14MnSb11 for use as a thermoelectric material. Yb14ZnSb11 is considered an intermediate valence Kondo system where some percentage of the Yb is formally 3+ and undergoes a reduction to 2+ at ~85 K. The substitution of a 3+ RE element could either replace the Yb3+ or add to the total amount of 3+ RE and provides changes to the electronic states. RE = Y, La were chosen as they represent the two extremes in size as substitutions for Yb: a similar and much larger size RE, respectively, compared with Yb3+. The composition x = 0.5 was chosen as that is the typical amount of RE element that can be substituted into Yb14MnSb11. These two new RE containing compositions show a significant improvement in Seebeck while decreasing thermal conductivity. The addition of RE increases the melting point of Yb14ZnSb11 so that the transport data from 300 K to 1275 K can be collected. The figure of merit is increased five times over that of Yb14ZnSb11 and provides a zT ~0.7 at 1275 K.