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Updated: Jul 15, 2026
Single-port Non-liposuction Endoscopic Axillary Lymph Node Dissection in Breast Cancer Surgery
Published on: April 3, 2026
Measuring surgeon performance of sentinel lymph node biopsy in breast cancer treatment by cumulative sum analysis
Lindsey Lerch1, James C Donald, Ivo A Olivotto
1Department of Surgery, Vancouver Island Health Authority, 302-2020 Richmond Road, Victoria, British Columbia, Canada V8R 6R5.
Background:
This study was performed to determine if surgeons' performance of sentinel lymph node biopsy (SLNB) for breast cancer varied with time and to devise a method to continuously evaluate that performance.
Methods:
We retrospectively examined the SLNB experience of 13 community surgeons performing 765 SLNBs and 579 concomitant axillary dissections. False-negative rates (FNRs) were assessed for individuals and cohorts defined by caseload. Performance with time was assessed using cumulative sum (CUSUM) analysis.
Results:
Overall, the SLN identification rate was 94.3%, and FNR was 5.3%. Each surgeon demonstrated variation in identification rate and/or FNR with time. CUSUM analysis provided an effective means to demonstrate when surgeon variation breached performance standards.
Conclusions:
Surgeon performance of SLNB varied with time, independent of case load. CUSUM may prove to be a useful statistical tool to evaluate performance before adopting stand-alone SLNB.
