Institutional Learning Curve for Sentinel Node Biopsy at a Community Teaching Hospital

Johnson, Jason M.; Orr, Richard K.; Moline, Stephanie R.
November 2001
American Surgeon;Nov2001, Vol. 67 Issue 11, p1030
Academic Journal
Sentinel lymph node biopsy (SLB) is gaining popularity as an alternative to axillary lymph node dissection for breast cancer staging. Although publications have described the inherent learning curve few have analyzed actual performance in community hospitals. This study analyzes the institutional learning curve for SLB in a community teaching hospital without a formal sentinel node credentialing policy. We conducted an analysis of the initial 96 SLBs performed by 15 general surgeons over a 34-month period. The main outcomes were rate of identification of sentinel node and accuracy of SLB. Overall SLB was successful in identifying one or more sentinel nodes (mean = 2.2) in 73 per cent of attempted cases. There were marked differences in performance of individual surgeons; identification rates varied from 25 to 100 per cent. Only one surgeon performed more than 15 procedures during the study period. Nineteen of 21 cases with positive nodes were correctly characterized (sensitivity = 90.5%; 95% confidence interval = 76100%; false negative rate = 9.5%). Our institutional learning curve was longer than high-volume individual experiences published in the literature, with a lower rate of sentinel node identification. SLB appears to be sensitive for detecting malignancy, but the small number of patients with positive nodes in our series limits our conclusions. The marked variability in individual surgeon performances and the slow rate of overall improvement in our institution suggest a need for a formalized policy for SLB training.


Related Articles

  • Modern surgical treatment of malignant skin melanoma: A brief literature overview. Strashilov, Strahil; Yordanov, Angel // Australasian Medical Journal;2018, Vol. 11 Issue 12, p538 

    Background: Malignant melanoma (MM) of the skin is a rare, highly malignant tumour, affecting younger age. Its incidence rate has been rising as compared to all malignant neoplasms - 5 per cent of all newly diagnosed cancers in men, and 6 per cent of those in women. Aims: The aim of the...

  • Scalene Node Biopsy. Lillington, G.A.; Jamplis, R.W. // Annals of Internal Medicine;Jul63 Part 1, Vol. 59 Issue 1, p101 

    Reviews developments regarding scalene node biopsy. Anatomical considerations; Surgical considerations; Pathological considerations; Biopsy of palpable and nonpalpable scalene nodes; Bronchogenic carcinoma; Alveolar cell carcinoma; Other malignant diseases.

  • Mesantoin Lymphadenopathy Morphologically Simulating Hodgkin's Disease. Doyle, A.P.; Hellstrom, H.R. // Annals of Internal Medicine;Sep63, Vol. 59 Issue 3, p363 

    Presents the case of a 36-year-old man with lymphadenopathy that occurred during the course of Mesantoin therapy. Observation of cells of Reed-Sternberg type in the second biopsy; Lymph node biopsies; Characteristic clinical course of lymphadenopathy.

  • IMAGE-GUIDED FINE-NEEDLE ASPIRATION CYTOLOGY OF DEEP-SEATED ENLARGED LYMPH NODES. Saikia, U. Nahar; Khirdwadkar, N.; Saikia, B.; Sood, B.; Goldsmith, R.; Dey, P.; Gupta, S.K. // Acta Radiologica;Mar2002, Vol. 43 Issue 2, p230 

    Purpose: To evaluate the role of image-guided fine-needle aspiration cytology (FNAC) of deep-seated lymph nodes. Material and Methods: Image-guided FNACs were performed on 242 patients of deep-seated lymph nodes which included thoracic, retroperitoneal and abdominal nodes. A sterile 3.5/5-MHz...

  • Corrections and clarifications.  // BMJ: British Medical Journal;1/19/2013, Vol. 346 Issue 7891, p18 

    A correction to the article “Sentinel node biopsy for melanoma: unnecessary treatment?” that was published in the January 8, 2013 issue is presented.

  • The Sentinel Node Biopsy in Melanoma. Landi, Giorgio; Landi, Christian // Dermatology Nursing;Dec2001, Vol. 13 Issue 6, p429 

    Discusses sentinel node (SN) biopsy in patients with malignant melanoma (MM). Sign of regional metastasis of MM; How excised SN is studied; Risk of not treating metastatic non-SN; Success rate of identifying and harvesting SN using lymphoscintigraphy and lymphatic mapping with patent blue dye...

  • You Be the Coder.  // General Surgery Coding Alert;Apr2010, Vol. 12 Issue 4, p27 

    The article offers information on the importance of separately coding the sentinel lymph node biopsy through appropriate coding.

  • Hospital performs 1st Sentinel node biopsy to discover cancer.  // Hudson Valley Business Journal;03/13/2000, Vol. 11 Issue 2, p14 

    Reports that the Saint Luke's Hospital in Newburgh, New York has performed its first sentinel node biopsy. Function of the procedure; Traditional procedure used; Benefits from using sentinel node biopsy.

  • Scaling back on lymph node dissection: time for a new standard? Tripathy, Debu // Hem/Onc Today;4/25/2011, Vol. 12 Issue 8, p16 

    The author discusses the trials to assess the outcomes from sentinel lymph node biopsy (SLNB) and omission of the full axillary lymph node dissection, with emphasis on the American College of Surgeons Oncology Group Z0011 trial.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics