Learning curve for identification of sentinel lymph node based on a cumulative sum analysis in gastric cancer.
OBJECTIVE
Lymph node metastasis is the most important point to consider when deciding on the modality of resection in patients with early gastric cancer. This study was conducted to evaluate the learning curve for identification of sentinel lymph nodes in patients with gastric cancer.


METHODS
The investigators included the results from 2 prospective series of sentinel lymph node mapping. Cumulative sum (CUSUM) analysis was performed to assess the learning curves for identification of sentinel lymph nodes at CUSUM target success rates of 95%.


RESULTS
One surgeon performed 135 sentinel lymph node mappings for 2 prospective series. The success rate exceeded 90%. The learning period for gastric cancer sentinel node mapping was calculated to be 26 cases for achieving a 95% success rate. Multiple logistic regression analysis for successful detection of sentinel nodes showed that surgical experience of sentinel lymph node mapping was an independent factor for successful detection of sentinel nodes.


CONCLUSIONS
This study suggests that the learning period for identification of sentinel lymph nodes in gastric cancer would be 26 cases. In clinical trials for gastric cancer with sentinel lymph node mapping, the learning curve should be considered to minimize bias due to surgical factors.
Lee
J H
JH
Gastric Cancer Branch, Research Institute for National Cancer Control and Evaluation, National Cancer Center, 111 Jungbalsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, Korea.
Ryu
K W
KW
Lee
S E
SE
Cho
S J
SJ
Lee
J Y
JY
Kim
C G
CG
Choi
I J
IJ
Kook
M C
MC
Kim
M J
MJ
Park
S R
SR
Lee
J S
JS
Nam
B H
BH
Kim
Y W
YW
D000328:Adult; D000368:Aged; D002983:Clinical Competence; D055088:Early Detection of Cancer; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010819:Physician's Role; D011379:Prognosis; D012044:Regression Analysis; D012107:Research Design; D021701:Sentinel Lymph Node Biopsy; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*