title: Troubleshooting Sentinel Lymph Node Biopsy in Breast Cancer Surgery.
abstract: Performing a sentinel lymph node biopsy (SLNB) is the standard of care for axillary nodal staging in patients with invasive breast cancer and clinically negative nodes. The procedure provides valuable staging information with few complications when performed by experienced surgeons. However, variation in proficiency exists for this procedure, and a great amount of experience is required to master the technique, especially when faced with challenging cases. The purpose of this paper was to provide a troubleshooting guide for commonly encountered technical difficulties in SLNB, and offer potential solutions so that surgeons can improve their own technical performance from the collective knowledge of experienced specialists in the field.
  
  
  
  Information was obtained from a convenience sample of six experienced breast cancer specialists, each actively involved in training surgeons and residents/fellows in SLNB. Each surgeon responded to a structured interview in order to provide salient points of the SLNB procedure.
  
  
  
  Four of the key opinion surgical specialists provided their perspective using technetium-99 m sulfur colloid, and two shared their experience using blue dye only. Distinct categories of commonly encountered problem scenarios were presented and agreed upon by the panel of surgeons. The responses to each of these scenarios were collected and organized into a troubleshooting guide.
  
  
  
  We present a compilation of 'tips' organized as a troubleshooting guide to be used to guide surgeons of varying levels of experience when encountering technical difficulties with SLNB.
authors.affiliation: Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA. ted.james@uvm.edu.|Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. ted.james@uvm.edu.
authors.forename: Ted A
authors.initials: TA
authors.lastname: James
authors.affiliation: Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Alex R
authors.initials: AR
authors.lastname: Coffman
authors.affiliation: Department of Surgery, Yale University, New Haven, CT, USA.
authors.forename: Anees B
authors.initials: AB
authors.lastname: Chagpar
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Judy C
authors.initials: JC
authors.lastname: Boughey
authors.affiliation: Department of Surgery, University of Arkansas, Little Rock, AR, USA.
authors.forename: V Suzanne
authors.initials: VS
authors.lastname: Klimberg
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
authors.affiliation: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Armando E
authors.initials: AE
authors.lastname: Giuliano
authors.affiliation: Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Seth P
authors.initials: SP
authors.lastname: Harlow
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002983:Clinical Competence; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D009367:Neoplasm Staging; D000071036:Sentinel Lymph Node / Q000473:pathology* / Q000601:surgery*; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects / Q000379:methods*; D013671:Technetium Tc 99m Sulfur Colloid
chemical_list: D004396:Coloring Agents; D013671:Technetium Tc 99m Sulfur Colloid