Credentialing for Breast Lymphatic Mapping: How Many Cases Are Enough?
- 1 May 1999
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 229 (5), 723
- https://doi.org/10.1097/00000658-199905000-00015
Abstract
Objective To evaluate credentialing issues for sentinel lymphatic mapping for breast cancer. Summary Background Data The sentinel lymph node (SLN) is defined as the first lymph node receiving lymphatic drainage from a tumor. The SLN accurately reflects the status of the axillary nodes in patients with early-stage breast cancer, and SLN mapping is gaining widespread acceptance. Few of the many published feasibility studies of lymphatic mapping for breast cancer have adequate numbers to assess credentialing issues for this new procedure. Methods Five hundred consecutive SLN biopsies were performed at one institution, over a 20-month period, by eight surgeons, using isosulfan blue dye and technetium-labeled sulfur colloid. The authors reviewed each surgeon’s success rate in finding the SLN, and false-negative rate, relative to level of experience with the technique. Results Lymphatic mapping performed by an experienced surgeon (surgeon A, B, or C) was associated with a higher success rate (94%) than when it was performed by one with less experience (86%). Ten failed mapping procedures occurred in the first 100 cases. For each of the ensuing 100 cases, there were eight, six, six, and four failed mapping procedures, suggesting that increasing experience does not eradicate failed mapping procedures completely. The false-negative rate among 104 patients in whom axillary dissection was planned in advance was 10.6% (5/47). Most false-negative results occurred early in the surgeon’s experience: when the first six cases of every surgeon were excluded, the false-negative rate fell to 5.2% (2/38). Conclusions With increasing experience, failed SLN localizations and false-negative SLN biopsies occur less often. Combined dye and isotope localization, enhanced histopathology, a backup axillary dissection, and judicious case selection are required to avoid the high false-negative rate of one’s early experience.Keywords
This publication has 29 references indexed in Scilit:
- The Sentinel Node in Breast Cancer — A Multicenter Validation StudyNew England Journal of Medicine, 1998
- Sentinel Lymph Node Biopsy in Breast Cancer: Initial Experience at Memorial Sloan-Kettering Cancer CenterJournal of the American College of Surgeons, 1998
- Intradermal blue dye to identify sentinel lymphnode in breast cancerThe Lancet, 1997
- Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodesThe Lancet, 1997
- Lymphatic mapping and sentinel node biopsy in the patient with breast cancerPublished by American Medical Association (AMA) ,1996
- Adjuvant Cyclophosphamide, Methotrexate, and Fluorouracil in Node-Positive Breast Cancer — The Results of 20 Years of Follow-upNew England Journal of Medicine, 1995
- Lymphatic Mapping and Sentinel Lymphadenectomy for Breast CancerAnnals of Surgery, 1994
- Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probeSurgical Oncology, 1993
- Technical Details of Intraoperative Lymphatic Mapping for Early Stage MelanomaArchives of Surgery, 1992
- Surgical Adjuvant Chemotherapy in Cancer of the BreastAnnals of Surgery, 1968