Beyond the false negative rate: development of quality indicators for sentinel lymph node biopsy in breast cancer.
BACKGROUND
Sentinel lymph node biopsy (SNLB) has been adopted as the standard method of axillary staging for women with clinically node-negative early-stage breast cancer. The false negative rate as a quality indicator is impractical given the need for a completion axillary dissection to calculate. The objective of this study was to develop practical quality indicators for SLNB using an expert consensus method and to determine if they were feasible to measure.


METHODS
We used a modified Delphi consensus process to develop quality indicators for SLNB. A multidisciplinary expert panel reviewed potential indicators extracted from the medical literature to select quality indicators that were relevant and measurable. Feasibility was determined by abstracting the quality indicator variables from a retrospective chart review.


RESULTS
The expert panel prioritized 11 quality indicators as benchmarks for assessing the quality of surgical care in SNLB. Nine of the indicators were measurable at the chart or institutional level.


CONCLUSIONS
A systematic evidence- and consensus-based approach was used to develop measurable quality indicators that could be used by practicing surgeons and administrators to evaluate performance of SLNB in breast cancer.
Quan
May Lynn
ML
Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. maylynn.quan@sunnybrook.ca
Wells
Bryan J
BJ
McCready
David
D
Wright
Frances C
FC
Fraser
Novlette
N
Gagliardi
Anna R
AR
D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic / Q000592:standards; D019984:Quality Indicators, Health Care; D021701:Sentinel Lymph Node Biopsy