Improvement in sentinel node biopsy results in a teaching community hospital: results of a multidisciplinary quality improvement program.

摘要

BACKGROUND: In 2001 we reported poor results for sentinel node biopsy and marked variability among surgeons. Subsequently, we initiated a multidisciplinary protocol involving standardized radiocolloid injection, physician education, and surgeon proctoring. METHODS: The current study presents follow-up data (2004-2006) after this quality improvement initiative. Data recorded included technical details and patient factors, related to each surgeon. Results were compared with our previously published data. RESULTS: The overall identification rate was improved markedly from 2001 (92% vs 66%). Eleven general surgeons performed 151 sentinel node biopsies. Seven surgeons had a 100% identification rate, the others had identification rates of 84% (N = 44), 86% (N = 29), 92% (N = 12), and 0% (N = 1). Differences still persist among surgeons, including number of sentinel nodes sampled, performance of axillary dissections, and breast conservation. CONCLUSIONS: A multidisciplinary protocol improved sentinel node biopsy performance in a community teaching hospital. However, further work is needed to standardize and improve overall breast surgery results.