The Sentinel Node in Breast Cancer — A Multicenter Validation Study

The histologic status of axillary lymph nodes, one of the most important prognostic indicators in patients with breast cancer, directly affects clinical management. 1 However, over 80 percent of women who undergo axillary dissection have at least one postoperative complication in the arm, and psychological distress is common. 2 – 5 A potential alternative to axillary lymphadenectomy is sentinel-node resection. The first stop along the route of lymphatic drainage from a primary tumor is a limited set of regional lymph nodes. 6 Dyes, radiographic contrast agents, and radioactive tracers have been used to identify such lymph nodes. 7 – 13 More than 20 years ago, Cabanas . . 

Prerandomization surgical training for the national surgical adjuvant breast and bowel project (NSABP) B-32 trial: A randomized phase III clinical trial to compare sentinel node resection to conventional axillary dissection in clinically node-negative breast cancer

OBJECTIVE: To train surgeons in a standardized technique of sentinel lymph node biopsy and to prepare them for the requirements of a prospective randomized surgical trial. SUMMARY BACKGROUND DATA: The NSABP B32 trial opened to accrual in May 1999. A significant component of this trial was a prerandomization training phase of surgeons performed by a group of core surgical trainers. The goals of this training phase were to expeditiously instruct surgeons in a standardized technique of sentinel lymph node biopsy and to educate those same surgeons in complete and accurate data collection and source documentation for the trial. METHODS: This study is a description of the training data collected in a prospective fashion for the training component for surgeon entry into the B32 trial, evaluating the effectiveness of the training program in regards to surgical outcomes and protocol compliance. RESULTS: Two hundred twenty-six registered surgeons underwent site visit training by a core surgical trainer and 187 completed training and were approved to randomize patients on the trial. The results of 815 training (nontrial) cases demonstrated a technical success rate for identifying sentinel nodes at 96.2% with a false negative rate of 6.7%. A protocol compliance analysis, which included the evaluation of 94 separate fields, showed mean protocol compliance of 98.6% for procedural fields, 95.5% for source documentation fields and 95.0% for data entry fields. CONCLUSIONS: This training and quality control program has resulted in a large number of surgeons capable of performing sentinel lymph node biopsy in a standardized fashion with a high degree of protocol compliance and pathologic accuracy. This will ensure optimal results for procedures performed on the randomized phase of the trial