Sentinel lymph node biopsy for breast cancer using methylene blue dye manifests a short learning curve among experienced surgeons: a prospective tabular cumulative sum (CUSUM) analysis

摘要: The benefits of sentinel lymph node biopsy (SLNB) for breast cancer patients with histologically negative axillary nodes, in whom dissection (ALND) is thereby avoided, are now established. Low false rate, certainly blue dye technique, mostly reflects the established high inherent accuracy SLNB and low nodal metastatic load (subject to patient selection). SLN identification rate influenced by volume, injection site choice mapping agent, load, location skill at dissection. Being more subject technical failure, seems be a reasonable variable learning curve assessment than rate. Methylene as good an agent Isosulfan much cheaper. Addition radio-colloid does not achieve sufficiently higher justify cost. therefore developing countries. American Society Breast Surgeons recommends that, competence, surgeons should perform 20 but admits that standardized technique may "much shorter". One appropriate remedy this dilemma plot individual curves. Using methylene dye, experienced performed selected (primary tumor < 5 cm clinically ipsilateral axilla). Intraoperative completion ALND were standardization on first 13 24 cases. was plotted each surgeon tabular cumulative sum (CUSUM) chart sequential probability ratio test (SPRT) limits based target 85%. CUSUM crossed SPRT limit line after 8 consecutive, positively identified SLN, signaling achievement acceptable level competence. Tabular charting, justified parameters, indicates using completed SLN. charting used curves trainee applying proxy parameter failure presence mentor (such failed within 15 minutes).