Defining the optimal surgeon experience for breast cancer sentinel lymph node biopsy

A model for implementation of new surgical techniques

Kelly M. McMasters, Sandra L. Wong, Celia Chao, Claudine Woo, Todd M. Tuttle, R. Dirk Noyes, David J. Carlson, Alison L. Laidley, Terre Q. McGlothin, Philip B. Ley, C. Matthew Brown, Rebecca L. Glaser, Robert E. Pennington, Peter S. Turk, Diana Simpson, Michael J. Edwards

Research output: Contribution to journalArticle

200 Citations (Scopus)

Abstract

Objective: To determine the optimal experience required to minimize the false-negative rate of sentinel lymph node (SLN) biopsy for breast cancer. Summary Background Data: Before abandoning routine axillary dissection in favor of SLN biopsy for breast cancer, each surgeon and institution must document acceptable SLN identification and false-negative rates. Although some studies have examined the impact of individual surgeon experience on the SLN identification rate, minimal data exist to determine the optimal experience required to minimize the more crucial false-negative rate. Methods: Analysis was performed of a large prospective multiinstitutional study involving 226 surgeons. SLN biopsy was performed using blue dye, radioactive colloid, or both. SLN biopsy was performed with completion axillary LN dissection in all patients. The impact of surgeon experience on the SLN identification and false-negative rates was examined. Logistic regression analysis was performed to evaluate independent factors in addition to surgeon experience associated with these outcomes. Results: A total of 2,148 patients were enrolled in the study. Improvement in the SLN identification and false-negative rates was found after 20 cases had been performed. Multivariate analysis revealed that patient age, nonpalpable tumors, and injection of blue dye alone for SLN biopsy were independently associated with decreased SLN identification rates, whereas upper outer quadrant tumor location was the only factor associated with an increased false-negative rate. Conclusions: Surgeons should perform at least 20 SLN cases with acceptable results before abandoning routine axillary dissection. This study provides a model for surgeon training and experience that may be applicable to the implementation of other new surgical technologies.

Original languageEnglish (US)
Pages (from-to)292-300
Number of pages9
JournalAnnals of Surgery
Volume234
Issue number3
DOIs
StatePublished - 2001
Externally publishedYes

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Sentinel Lymph Node Biopsy
Breast Neoplasms
Dissection
Coloring Agents
Colloids
Surgeons
Sentinel Lymph Node
Neoplasms
Multivariate Analysis
Logistic Models
Regression Analysis
Prospective Studies
Technology
Injections

ASJC Scopus subject areas

  • Surgery

Cite this

Defining the optimal surgeon experience for breast cancer sentinel lymph node biopsy : A model for implementation of new surgical techniques. / McMasters, Kelly M.; Wong, Sandra L.; Chao, Celia; Woo, Claudine; Tuttle, Todd M.; Noyes, R. Dirk; Carlson, David J.; Laidley, Alison L.; McGlothin, Terre Q.; Ley, Philip B.; Brown, C. Matthew; Glaser, Rebecca L.; Pennington, Robert E.; Turk, Peter S.; Simpson, Diana; Edwards, Michael J.

In: Annals of Surgery, Vol. 234, No. 3, 2001, p. 292-300.

Research output: Contribution to journalArticle

McMasters, KM, Wong, SL, Chao, C, Woo, C, Tuttle, TM, Noyes, RD, Carlson, DJ, Laidley, AL, McGlothin, TQ, Ley, PB, Brown, CM, Glaser, RL, Pennington, RE, Turk, PS, Simpson, D & Edwards, MJ 2001, 'Defining the optimal surgeon experience for breast cancer sentinel lymph node biopsy: A model for implementation of new surgical techniques', Annals of Surgery, vol. 234, no. 3, pp. 292-300. https://doi.org/10.1097/00000658-200109000-00003
McMasters, Kelly M. ; Wong, Sandra L. ; Chao, Celia ; Woo, Claudine ; Tuttle, Todd M. ; Noyes, R. Dirk ; Carlson, David J. ; Laidley, Alison L. ; McGlothin, Terre Q. ; Ley, Philip B. ; Brown, C. Matthew ; Glaser, Rebecca L. ; Pennington, Robert E. ; Turk, Peter S. ; Simpson, Diana ; Edwards, Michael J. / Defining the optimal surgeon experience for breast cancer sentinel lymph node biopsy : A model for implementation of new surgical techniques. In: Annals of Surgery. 2001 ; Vol. 234, No. 3. pp. 292-300.
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abstract = "Objective: To determine the optimal experience required to minimize the false-negative rate of sentinel lymph node (SLN) biopsy for breast cancer. Summary Background Data: Before abandoning routine axillary dissection in favor of SLN biopsy for breast cancer, each surgeon and institution must document acceptable SLN identification and false-negative rates. Although some studies have examined the impact of individual surgeon experience on the SLN identification rate, minimal data exist to determine the optimal experience required to minimize the more crucial false-negative rate. Methods: Analysis was performed of a large prospective multiinstitutional study involving 226 surgeons. SLN biopsy was performed using blue dye, radioactive colloid, or both. SLN biopsy was performed with completion axillary LN dissection in all patients. The impact of surgeon experience on the SLN identification and false-negative rates was examined. Logistic regression analysis was performed to evaluate independent factors in addition to surgeon experience associated with these outcomes. Results: A total of 2,148 patients were enrolled in the study. Improvement in the SLN identification and false-negative rates was found after 20 cases had been performed. Multivariate analysis revealed that patient age, nonpalpable tumors, and injection of blue dye alone for SLN biopsy were independently associated with decreased SLN identification rates, whereas upper outer quadrant tumor location was the only factor associated with an increased false-negative rate. Conclusions: Surgeons should perform at least 20 SLN cases with acceptable results before abandoning routine axillary dissection. This study provides a model for surgeon training and experience that may be applicable to the implementation of other new surgical technologies.",
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T1 - Defining the optimal surgeon experience for breast cancer sentinel lymph node biopsy

T2 - A model for implementation of new surgical techniques

AU - McMasters, Kelly M.

AU - Wong, Sandra L.

AU - Chao, Celia

AU - Woo, Claudine

AU - Tuttle, Todd M.

AU - Noyes, R. Dirk

AU - Carlson, David J.

AU - Laidley, Alison L.

AU - McGlothin, Terre Q.

AU - Ley, Philip B.

AU - Brown, C. Matthew

AU - Glaser, Rebecca L.

AU - Pennington, Robert E.

AU - Turk, Peter S.

AU - Simpson, Diana

AU - Edwards, Michael J.

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N2 - Objective: To determine the optimal experience required to minimize the false-negative rate of sentinel lymph node (SLN) biopsy for breast cancer. Summary Background Data: Before abandoning routine axillary dissection in favor of SLN biopsy for breast cancer, each surgeon and institution must document acceptable SLN identification and false-negative rates. Although some studies have examined the impact of individual surgeon experience on the SLN identification rate, minimal data exist to determine the optimal experience required to minimize the more crucial false-negative rate. Methods: Analysis was performed of a large prospective multiinstitutional study involving 226 surgeons. SLN biopsy was performed using blue dye, radioactive colloid, or both. SLN biopsy was performed with completion axillary LN dissection in all patients. The impact of surgeon experience on the SLN identification and false-negative rates was examined. Logistic regression analysis was performed to evaluate independent factors in addition to surgeon experience associated with these outcomes. Results: A total of 2,148 patients were enrolled in the study. Improvement in the SLN identification and false-negative rates was found after 20 cases had been performed. Multivariate analysis revealed that patient age, nonpalpable tumors, and injection of blue dye alone for SLN biopsy were independently associated with decreased SLN identification rates, whereas upper outer quadrant tumor location was the only factor associated with an increased false-negative rate. Conclusions: Surgeons should perform at least 20 SLN cases with acceptable results before abandoning routine axillary dissection. This study provides a model for surgeon training and experience that may be applicable to the implementation of other new surgical technologies.

AB - Objective: To determine the optimal experience required to minimize the false-negative rate of sentinel lymph node (SLN) biopsy for breast cancer. Summary Background Data: Before abandoning routine axillary dissection in favor of SLN biopsy for breast cancer, each surgeon and institution must document acceptable SLN identification and false-negative rates. Although some studies have examined the impact of individual surgeon experience on the SLN identification rate, minimal data exist to determine the optimal experience required to minimize the more crucial false-negative rate. Methods: Analysis was performed of a large prospective multiinstitutional study involving 226 surgeons. SLN biopsy was performed using blue dye, radioactive colloid, or both. SLN biopsy was performed with completion axillary LN dissection in all patients. The impact of surgeon experience on the SLN identification and false-negative rates was examined. Logistic regression analysis was performed to evaluate independent factors in addition to surgeon experience associated with these outcomes. Results: A total of 2,148 patients were enrolled in the study. Improvement in the SLN identification and false-negative rates was found after 20 cases had been performed. Multivariate analysis revealed that patient age, nonpalpable tumors, and injection of blue dye alone for SLN biopsy were independently associated with decreased SLN identification rates, whereas upper outer quadrant tumor location was the only factor associated with an increased false-negative rate. Conclusions: Surgeons should perform at least 20 SLN cases with acceptable results before abandoning routine axillary dissection. This study provides a model for surgeon training and experience that may be applicable to the implementation of other new surgical technologies.

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