Improvement to visualization of nodes in breast cancer patients following audit: are we seeing the problem?

Successful localization of nodes in breast cancer patients depends upon the effectiveness of the lymphoscintigraphy technique employed. A benefit of performing imaging as part of this procedure is that it allows sites to audit their technique. An audit of breast cancer patients at the Glasgow Royal Infirmary (GRI) hospital showed nodes to be visualized in only 81% of patients. Current guidelines state that nodes should be seen in more than 95% of patients. A period of investigation and review led to changes being made to the injection and imaging technique employed at the GRI site. Following these changes a re-audit was performed that showed that the node visualization rate has successfully been increased to 97%, thereby meeting the standards set in the guidelines. This technical note details the results of the initial audit and re-audit, and explains the investigation and changes made to clinical procedures at the GRI site to improve the node visualization rate. The challenges that can occur when performing breast sentinel node procedures are also discussed.