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Sep 14, 2007Article Details
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Main Article Content
Sentinel lymph node biopsy in breast cancer – a modified audit for surgeons in private practice
Abstract
Background. Sentinel lymph node biopsy (SLNB) is a technique
that is widely used in the management of early breast cancer.
Surgeons are encouraged to validate their initial SLNB
results by performing an audit in which both a SLNB and an
axillary lymph node dissection (ALND) are performed. For
surgeons in solo private practice this is not financially viable
as the SLNB would not be paid for by the medical insurance
companies.
Methods. Forty consenting patients were enrolled in the audit.
The initial 5 patients (group A) were entered into a traditional
audit – an ALND and a SLNB. The next 35 patients (group
B) formed part of a modified audit – an axillary sample was
performed if the sentinel node was negative (group B1) and an
ALND if the node was positive (group B2).
Results. Ninety-two per cent of patients with an ipsilateral
sentinel axillary node on preoperative scintigraphy had their
node identified at the time of surgery. Eight patients had
evidence of lymphatic spread. Two patients had parasternal
sentinel nodes which were not removed. Group A had a mean
of 10.8 nodes removed, group B1 5.8 nodes, and group B2
13.2 nodes. Twenty-three of 35 patients (66%) in group B were
spared an axillary dissection.
Conclusion. The modified audit of group B allowed patients to
benefit from the procedure (and thus the medical aids charged)
and yet permitted our team to ascertain the accuracy of the
technique in our hands. We feel this is an approach that may
be used by other surgeons working alone.
South African Medical Journal Vol. 97 (6) 2007: pp. 451-455
