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In the audit phase of the ALMANAC (Axillary Lymphatic Mapping Against Nodal Axillary Clearance) study 31 surgeons from units throughout the UK contributed 842 patients. Localisation of sentinel node was with both blue dye and radioisotope. There were 33 failed localizations (3•9%). Factors influencing failure to localize a sentinel node have been analysed. Results: The time interval between injection of the radioisotope to the axillary incision was not significantly related to successful sentinel node localisation. Age, an important factor identified by some groups, was also not a significant factor related to success of sentinel node biopsy; neither was size or grade of the tumour. Site of the tumour which was recorded in 521 patients did influence failure to localize sentinel nodes, failure being more common in inner tumours (12/154 failures, rate 22%) compared with other locations failure (8/367 failures, rate 2•2%) P = 0•008. There was also a significant correlation between successful localization of a sentinel node and body mass index with the highest failure rate being in women with a body mass index over 30, P < 0•0001. The presence of nodes on a pre-operative scintiscan significantly predicted for success -scan outcome known in 799, successful localization in 541/550 positive scans, 98•3% versus 226/249 negative scans, 90•8%, P < 0•0001. Conclusions: These demonstrate that in a large multicentre study, sentinel node mapping success is influenced by tumour location, body mass index and visualization of nodes on a pre-operative scintigram.
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