Outcomes of sentinel node biopsy for breast cancer in British Columbia, 1996 to 2001

doi:10.1016/S0002-9610(02)01215-1

The American Journal of Surgery

Volume 185, Issue 2, February 2003, Pages 118-126

https://doi.org/10.1016/S0002-9610(02)01215-1 Get rights and content

Abstract

Background

This study evaluated the outcomes of the first 5 years of sentinel node biopsy (SNB) in British Columbia (BC), Canada, 1996 to 2001.

Methods

There were 547 SNB procedures for breast cancer performed by 29 surgeons at 12 hospitals in BC between October 1996 and July 2001. Identification, accuracy, and false-negative rates were determined and correlated to patient, tumor, and surgical factors with the chi-square test.

Results

SNB mapping was performed using blue dye alone (15%), radiopharmaceutical alone (6%), or both (79%). A completion axillary dissection was performed in 93%. A median of 2 (range 1 to 16) sentinel nodes was biopsied. The overall identification rate was 88%, accuracy was 92%, and false-negative rate was 22%. All rates were improved in younger (age <50 years) compared with older women. A positive lymphoscintiscan and the mapping agent used were associated with higher identification rates but not accuracy or false negative rates. Increasing surgeon experience was not significantly associated with improvements in identification or false-negative rates.

Conclusions

The potential of SNB was not fully translated into surgical practice in BC by 2001.

Section snippets

Patients

The BC Cancer Agency (BCCA) is a provincial organization with a broad-based mandate including all elements of cancer control [21]. The BCCA maintains a province-wide electronic database of cancer records for patients assessed or treated at the BCCA. The database contains prospectively collected demographic, prognostic, treatment, and outcome information. From this database patients with breast cancer who had one or more SNB were identified. In addition, 29 surgeons from 12 hospitals were

Results

Between October 1996 and July 2001, 29 surgeons in 12 hospitals performed 547 lymphatic mapping procedures and SNB in 540 women (7 with bilateral procedures) in British Columbia. The mean number of SNB per surgeon was 19 (range 1 to 80). The numbers of surgeons who performed 1 to 10, 11 to 20, 21 to 30, and greater than 30 procedures were 14 (48%), 6 (21%), 5 (17%), and 4 (14%), respectively.

Comments

Cancer control in the province of BC is characterized by a broad government-appointed mandate including all elements of cancer control for the province [21]. These include the development and dissemination of consensus practice guidelines about the full spectrum of cancer care, and coordination of cancer treatment services. A multidisciplinary group comprising both BCCA and community physicians and surgeons regularly review and publish recommendations for cancer management, including breast

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Scientific paperOutcomes of sentinel node biopsy for breast cancer in British Columbia, 1996 to 2001

Abstract

Background

Methods

Results

Conclusions

Section snippets

Patients

Results

Comments

J Am Stat Soc

Surg Clin North Am

J Am Coll Surg

Am J Surg

Surgery

J Am Coll Surg

Lancet

Am J Surg

Clinical practice guidelines for the care and treatment of breast cancer13. Sentinel lymph node biopsy

Can Med Assoc J

Clinical practice guidelines for the care and treatment of breast cancer4. Axillary dissection

Can Med Assoc J

Clinical practice guidelines for the management of early breast cancer

Treatment of early stage breast cancer

JAMA

Lymphatic mapping and sentinel lymphadenectomy for breast cancer

Ann Surg

Lymphatic mapping and sentinel node biopsy in the patient with breast cancer

JAMA

Sentinel lymphadenectomy in breast cancer

J Clin Oncol

The sentinel node in breast cancera multicentre study

N Engl J Med

Sentinel lymph node biopsy and axillary dissection in breast cancerresults in a large series

J Natl Cancer Inst

Intraoperative lymphatic mapping and sentinel lymph node dissection in breast cancer

CA Cancer J Clin

The role of selective sentinel lymph node dissection in breast cancer

Surg Clin North Am

Sentinel node biopsy is not an alternative to axillary dissection in breast cancer

J Surg Oncol

Credentialing for breast lymphatic mappinghow many cases are enough?

Ann Surg

Sentinel lymph node biopsy as an alternative to routine axillary lymph node dissection in breast cancer patients

J Surg Oncol

Sentinel lymph node biopsy as an alternative to routine axillary lymph node dissection in breast cancer patients

J Surg Oncol

The credentialing of American surgery

Ann Surg Oncol

Scientific paper
Outcomes of sentinel node biopsy for breast cancer in British Columbia, 1996 to 2001