Learning curve for the detection of axillary sentinel lymph node in breast cancer.
OBJECTIVE
Sentinel axillary lymph node (SALN) detection is a new technique. Surgeons must progress up a learning curve in order to guarantee quality and safety equivalent to axillary lymphadenectomy. To ensure accurate staging of patients this learning curve must include SALN detection and an axillary lymphadenectomy. The aim of our work was to validate the principles and evaluate the consequences of learning curve for SALN detection from a prospective series of 200 consecutive patients.


METHODS
Prospective assessment was made of the detection and false negative rates, post operative morbidity as abcess and seroma, and length of hospital stay.


RESULTS
We evaluated the performance from the first to the hundredth case for each surgeon. Detection rate improved to 85% after patient number 10. False negative rate was less than 6%. Post operative axillary morbidity included 11% of seromas and 2% of abcess. Mean hospital stay was 2.8 days.


CONCLUSIONS
Multidisciplinary validation of the learning period contributes to an accurate and safe SALN.
Classe
J M
JM
Service de Chirurgie Oncologique, Centre René Gauducheau, Site Hôpital Nord, Nantes, France. jm-classe@nantes.fnclcc.fr
Curtet
C
C
Campion
L
L
Rousseau
C
C
Fiche
M
M
Sagan
C
C
Resche
I
I
Pioud
R
R
Andrieux
N
N
Dravet
F
F
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D016009:Chi-Square Distribution; D002983:Clinical Competence; D005188:False Negative Reactions; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology*; D008495:Medical Oncology / Q000193:education*; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D021701:Sentinel Lymph Node Biopsy; D018709:Statistics, Nonparametric