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An Alternative Measure of Proficiency in Sentinel Node Biopsy for Breast Cancer
Ted A James, Lawrence E McCahill
University of Vermont, Burlington, VT

Objective: The purpose of this study was to determine performance standards for sentinel node biopsy as a quality measure, without relying on false-negative data from routine completion axillary node dissection.
Design: The institutional breast cancer database was cross referenced to the tumor registry in order to obtain pathology data on sentinel node biopsies. The average number of sentinel nodes obtained and the percentage of positive sentinel node metastasis were recorded.
Setting: Multidisciplinary breast center within a tertiary care academic healthcare facility.
Patients: The study was performed using pathology data of 159 patients with confirmed invasive breast carcinoma.
Interventions: All patients underwent successful axillary staging with sentinel node biopsy using the 10% rule for termination.
Main Outcome Measures: 1) Total yield of sentinel nodes, and 2) rate of nodal metastasis identified by sentinel node biopsy.
Results: The mean number of sentinel nodes removed was 3.8 (median 2) among all breast surgeons reviewed. There was a 19% positive sentinel node metastasis rate. No statistically significant variation was observed between surgeons.
Conclusions: Consistent patterns of performance for sentinel node biopsy have been identified at our institution which can serve as guidelines for continued competence. These proficiency targets may also be used to help validate surgeons new to sentinel node biopsy without requiring false-negative data from completion axillary dissection.


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