BACKGROUND: Sentinel lymph node biopsy (SLNB) is rapidly gaining acceptance as a diagnostic tool for staging breast cancer. OBJECTIVE: Analyze trends among surgeons and facilities in Kaiser Permanente Northern California (KPNC) in adopting SLNB to stage cases of breast cancer and assess success in locating the sentinel node. METHODS: Retrospective review of data for patients whose breast cancer was staged using SLNB and axillary lymph node dissection between July 1997 through December 2002 at KPNC. Rates of false-negative results were calculated and stratified by surgeons' experience with SLNB. RESULTS: The number of SLNB procedures performed each month increased steadily from fewer than ten (in late 1998) to about 80 per month (in mid-2002) and were done at 17 facilities. Of the 132 surgeons who performed SLNB, most had done fewer than 15 procedures. The false-negative result rate overall was 6.53% (95% CI 4.75%, 8.73%); for surgeons who performed <30 procedures the rate was 8.58% (95% CI 5.52%, 12.60%); for surgeons who performed 20 to 30 procedures the rate was 13.08% (95% CI 7.34%, 20.98%); and for surgeons who performed more than 30 procedures the rate was 5.05% (95% CI 3.07%, 7.78%). CONCLUSIONS: SLNB is rapidly being adopted at KPNC to stage cases of breast cancer and surgeons achieve an acceptable 6.53% false-negative result rate overall. The higher false-negative rate for surgeons who performed 20 to 30 procedures suggests that departments should expand efforts to monitor and proctor these surgeons.
BACKGROUND: Sentinel lymph node biopsy (SLNB) is rapidly gaining acceptance as a diagnostic tool for staging breast cancer. OBJECTIVE: Analyze trends among surgeons and facilities in Kaiser Permanente Northern California (KPNC) in adopting SLNB to stage cases of breast cancer and assess success in locating the sentinel node. METHODS: Retrospective review of data for patients whose breast cancer was staged using SLNB and axillary lymph node dissection between July 1997 through December 2002 at KPNC. Rates of false-negative results were calculated and stratified by surgeons' experience with SLNB. RESULTS: The number of SLNB procedures performed each month increased steadily from fewer than ten (in late 1998) to about 80 per month (in mid-2002) and were done at 17 facilities. Of the 132 surgeons who performed SLNB, most had done fewer than 15 procedures. The false-negative result rate overall was 6.53% (95% CI 4.75%, 8.73%); for surgeons who performed <30 procedures the rate was 8.58% (95% CI 5.52%, 12.60%); for surgeons who performed 20 to 30 procedures the rate was 13.08% (95% CI 7.34%, 20.98%); and for surgeons who performed more than 30 procedures the rate was 5.05% (95% CI 3.07%, 7.78%). CONCLUSIONS: SLNB is rapidly being adopted at KPNC to stage cases of breast cancer and surgeons achieve an acceptable 6.53% false-negative result rate overall. The higher false-negative rate for surgeons who performed 20 to 30 procedures suggests that departments should expand efforts to monitor and proctor these surgeons.
Authors: Todd M Tuttle; Theresa G Zogakis; Christy M Dunst; Richard T Zera; S Eva Singletary Journal: J Am Coll Surg Date: 2002-08 Impact factor: 6.113
Authors: U Veronesi; G Paganelli; V Galimberti; G Viale; S Zurrida; M Bedoni; A Costa; C de Cicco; J G Geraghty; A Luini; V Sacchini; P Veronesi Journal: Lancet Date: 1997-06-28 Impact factor: 79.321
Authors: C E Cox; F Haddad; S Bass; J M Cox; N N Ku; C Berman; A R Shons; T Yeatman; S Pendas; D S Reintgen Journal: Oncology (Williston Park) Date: 1998-09 Impact factor: 2.990
Authors: D Krag; D Weaver; T Ashikaga; F Moffat; V S Klimberg; C Shriver; S Feldman; R Kusminsky; M Gadd; J Kuhn; S Harlow; P Beitsch Journal: N Engl J Med Date: 1998-10-01 Impact factor: 91.245