Sentinel lymph node biopsy in breast cancer--a modified audit for surgeons in private practice

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.

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).

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.

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.