Evaluation of the quality of the sentinel lymph node biopsy procedure in patients with breast cancer

The Sentinel Lymph Node Biopsy (SLNB) has been demonstrated to be a safe alternative to axillary lymph node dissection in breast cancer staging. The multidisciplinary team must do it with rigor and demonstrate that they have fulfilled some essential criteria.

Objective

To evaluate the quality of the procedure in the Breast Pathology Unit of Hospital Puerta del Mar, using the self-evaluation guidelines of the Spanish Society of Senology and Breast Pathology.

Material and method

These guidelines establish some objective and measurable evaluation criteria related to the aspects that intervene in the SLNB. Each criterion is associated to 4 levels of quality standards. There are 3 essential criteria of mandatory fulfillment to implement SLNB in the clinical practice. They evaluate care experience (6 criteria), operative aspects (18 criteria, 3 essential) and scientific activity (8 indicators).

The initial validation phase included 50 patients and the application phase 120 patients (February 2009).

Results

Three essential criteria related to the detection of the sentinel node (98%), accredited sensitivity (90%), and mean number of axillary sentinel nodes (2.1) were fulfilled. The application of self-evaluation guidelines in our Unit obtained a global score of 39 out of 71 points, quality level II being the most prevalent.

Conclusion

During the validation phase, our unit fulfilled the criteria established to implement the procedure. Following that, the use of this guideline accredits the good practice of the SLNB procedure and makes it possible to identify the areas of improvement, in our case, those related to the scientific and training activities.