title: Measuring surgeon performance of sentinel lymph node biopsy in breast cancer treatment by cumulative sum analysis.
abstract: BACKGROUND
  This study was performed to determine if surgeons' performance of sentinel lymph node biopsy (SLNB) for breast cancer varied with time and to devise a method to continuously evaluate that performance.
  
  
  METHODS
  We retrospectively examined the SLNB experience of 13 community surgeons performing 765 SLNBs and 579 concomitant axillary dissections. False-negative rates (FNRs) were assessed for individuals and cohorts defined by caseload. Performance with time was assessed using cumulative sum (CUSUM) analysis.
  
  
  RESULTS
  Overall, the SLN identification rate was 94.3%, and FNR was 5.3%. Each surgeon demonstrated variation in identification rate and/or FNR with time. CUSUM analysis provided an effective means to demonstrate when surgeon variation breached performance standards.
  
  
  CONCLUSIONS
  Surgeon performance of SLNB varied with time, independent of case load. CUSUM may prove to be a useful statistical tool to evaluate performance before adopting stand-alone SLNB.
authors: Department of Surgery, Vancouver Island Health Authority, 302-2020 Richmond Road, Victoria, British Columbia, Canada V8R 6R5.
authors: Lindsey
authors: L
authors: Lerch
authors: James C
authors: JC
authors: Donald
authors: Ivo A
authors: IA
authors: Olivotto
authors: Mary
authors: M
authors: Lesperance
authors: Nick
authors: N
authors: van der Westhuizen
authors: Conrad
authors: C
authors: Rusnak
authors: Darren
authors: D
authors: Biberdorf
authors: Alison
authors: A
authors: Ross
authors: Allen
authors: A
authors: Hayashi
mesh_terms: D000368:Aged; D001706:Biopsy; D001943:Breast Neoplasms / Q000473:pathology*; D002983:Clinical Competence; D004650:Employee Performance Appraisal / Q000379:methods*; D013502:General Surgery / Q000592:standards*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000592:standards*; D013997:Time Factors