National practice patterns of sentinel lymph node dissection for breast carcinoma

Citation
A. Lucci et al., National practice patterns of sentinel lymph node dissection for breast carcinoma, J AM COLL S, 192(4), 2001, pp. 453-458
Citations number
25
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Surgery,"Medical Research Diagnosis & Treatment
Journal title
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
ISSN journal
1072-7515 → ACNP
Volume
192
Issue
4
Year of publication
2001
Pages
453 - 458
Database
ISI
SICI code
1072-7515(200104)192:4<453:NPPOSL>2.0.ZU;2-K
Abstract
BACKGROUND: The sentinel node is the first regional lymph node to receive t umor cells that metastasize through the lymphatic channel from a primary tu mor. The tumor status of the sentinel node should reflect the tumor status of the entire regional node basin. Sentinel lymph node dissection (SLND) ha s recently been investigated for use in patients with early breast carcinom a to avoid the sequelae of complete axillary lymph node dissection (ALND). published studies of SLND in breast cancer patients identify marked variati ons in technique, and there are few guidelines for credentialing surgeons t o perform SLND. STUDY DESIGN: The purpose of this study was to assess the current practice of SLND for breast cancer in the United States. A 27-item questionnaire was mailed to 1,000 randomly selected Fellows of the American College of Surge ons. Responses were anonymous. Statistical analysis was performed using SAS software (SAS Institute, Cary, NC). RESULTS: Response rate was 41% (n = 410), and 77% of those who responded pe rformed SLND for breast cancer. The majority (60%) of surgeons responding r outinely ordered preoperative lymphoscintigraphy. Of those who did lymphosc intigraphy, 28% removed internal mammary lymph nodes when lymphoscintigraph y showed drainage to these nodes. Ninety percent of surgeons used both blue dye and radiocolloid. Eighty percent of centers responding performed routi ne immunohistochemistry on sentinel lymph nodes, and 15% performed reverse transcription polymerase chain reaction. Ninety-six percent of surgeons per formed SLND for primary tumors 5 cm or smaller, and 95% performed SLND for an excisional cavity 6 cm and smaller. Twenty-eight percent performed SLND for high-grade ductal carcinoma in situ, and 28% of respondents performed 1 0 or fewer SLND procedures with subsequent ALND before performing SLND alon e. Surgeons learned SLND through courses (35%), oncology fellowships (26%), observation of other surgeons (31%), or were self-taught (26%), CONCLUSIONS: The majority of surgeons in the United States use similar tech nique for SLND breast cancer. But, there was marked variation in the number of SLND cases validated by an ALND before performing SLND only. (J Am Coll Surg 2001;192:453-458. (C) 2001 by the American College of Surgeons).