BACKGROUND: New Start, a structured, validated, multidisciplinary training programme in sentinel lymph node biopsy (SLNB), was established to allow the introduction and rapid transfer of appropriate knowledge and technical skills to ensure safe and competent practice across the UK. METHODS: Multidisciplinary teams attended a theory/skills laboratory course, following which they performed 30 consecutive SLNBs, either concurrently with their standard axillary staging procedure (training model A) or as stand-alone SLNB (training model B). SLNB was performed according to a standard protocol using the combined technique of isotope ((99m) Tc-labelled albumin colloid) and blue dye. An accredited New Start trainer mentored the first five procedures in the participant's hospital, or all 30 if stand-alone. Validation standards for model A and B were a localization rate of at least 90 per cent. In addition, for model A only, in which a minimum of ten patients were required to be node-positive, a false-negative rate (FNR) of 10 per cent or less was required. RESULTS: From October 2004 to December 2008, 210 SLNB-naive surgeons, in 103 centres, performed 6685 SLNB procedures. The overall sentinel lymph node (SLN) localization rate was 98·9 (95 per cent confidence interval 98·6 to 99·1) per cent (6610 of 6685) and the FNR 9·1 (7·9 to 10·5) per cent (160 of 1757). The FNR was related to nodal yield, ranging from 14·8 per cent for one node and declining to 9·7, 6·6, 4·7 and 4·1 per cent for two, three, four and more than four SLNs respectively. No learning curve was identified for localization or FNR. CONCLUSION: The programme successfully trained a wide range of UK breast teams to perform safe SLNB and suggested that a standard injection protocol and structured multidisciplinary training can abolish learning curves.
BACKGROUND: New Start, a structured, validated, multidisciplinary training programme in sentinel lymph node biopsy (SLNB), was established to allow the introduction and rapid transfer of appropriate knowledge and technical skills to ensure safe and competent practice across the UK. METHODS: Multidisciplinary teams attended a theory/skills laboratory course, following which they performed 30 consecutive SLNBs, either concurrently with their standard axillary staging procedure (training model A) or as stand-alone SLNB (training model B). SLNB was performed according to a standard protocol using the combined technique of isotope ((99m) Tc-labelled albumin colloid) and blue dye. An accredited New Start trainer mentored the first five procedures in the participant's hospital, or all 30 if stand-alone. Validation standards for model A and B were a localization rate of at least 90 per cent. In addition, for model A only, in which a minimum of ten patients were required to be node-positive, a false-negative rate (FNR) of 10 per cent or less was required. RESULTS: From October 2004 to December 2008, 210 SLNB-naive surgeons, in 103 centres, performed 6685 SLNB procedures. The overall sentinel lymph node (SLN) localization rate was 98·9 (95 per cent confidence interval 98·6 to 99·1) per cent (6610 of 6685) and the FNR 9·1 (7·9 to 10·5) per cent (160 of 1757). The FNR was related to nodal yield, ranging from 14·8 per cent for one node and declining to 9·7, 6·6, 4·7 and 4·1 per cent for two, three, four and more than four SLNs respectively. No learning curve was identified for localization or FNR. CONCLUSION: The programme successfully trained a wide range of UK breast teams to perform safe SLNB and suggested that a standard injection protocol and structured multidisciplinary training can abolish learning curves.
Authors: Floris P R Verbeek; Susan L Troyan; J Sven D Mieog; Gerrit-Jan Liefers; Lorissa A Moffitt; Mireille Rosenberg; Judith Hirshfield-Bartek; Sylvain Gioux; Cornelis J H van de Velde; Alexander L Vahrmeijer; John V Frangioni Journal: Breast Cancer Res Treat Date: 2013-12-13 Impact factor: 4.872
Authors: Dominika Kozak; Iwona Głowacka-Mrotek; Tomasz Nowikiewicz; Zygmunt Siedlecki; Wojciech Hagner; Magdalena Sowa; Wojciech Zegarski Journal: Pathol Oncol Res Date: 2017-09-16 Impact factor: 3.201
Authors: Iwona Głowacka-Mrotek; Magdalena Tarkowska; Tomasz Nowikiewicz; Zygmunt Siedlecki; Wojciech Zegarski; Wojciech Hagner Journal: Contemp Oncol (Pozn) Date: 2018-12-31
Authors: Bello Inua; Victoria Fung; Nour Al-Shurbasi; Sarah Howells; Olga Hatsiopoulou; Praveen Somarajan; Gregory J Zardin; Norman R Williams; Stan Kohlhardt Journal: Mol Clin Oncol Date: 2021-01-21
Authors: Amit Goyal; G Bruce Mann; Lesley Fallowfield; Lelia Duley; Malcolm Reed; David Dodwell; Robert E Coleman; Apostolos Fakis; Robert Newcombe; Valerie Jenkins; Diane Whitham; Margaret Childs; David Whynes; Vaughan Keeley; Ian Ellis; Patricia Fairbrother; Shabina Sadiq; Kathryn Monson; Alan Montgomery; Wei Tan; Luke Vale; Tara Homer; Heath Badger; Rachel Helen Haines; Mickey Lewis; Daniel Megias; Zohal Nabi; Preetinder Singh; Andrei Caraman; Elizabeth Miles Journal: BMJ Open Date: 2021-12-02 Impact factor: 2.692