Quality Indicators for Sentinel Lymph Node Biopsy in Breast Cancer: Applicability and Clinical Relevance


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Sanjit Agrawal1,Rosina Ahmed1,Sachin Shenoy1
1Tata Medical Center

Abstract

Background

Sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) as the standard of care for management of early breast cancer. This study aimed to assess our newly set up SLNB program against 11 accepted and published quality indicators (QIs).

Method

All breast cancer patients who underwent SLNB in our tertiary care cancer center from June 2013 to Dec 2015 were included in the study. Clinical, pathological and follow up data were extracted from the institutional REDCap data system. 11 QIs were assessed. Analysis was done with SPSS 23.

Results

Following validation, 234 patients had SLNB, always performed along with primary surgery. Identification rate was 95.3% and >1 SLN was identified in 72% of patients. SLNB positivity was 33%, of these 100% underwent ALND. Overall 91 % of QI eligible patients underwent SLNB. No ineligible patients (T4) underwent SLNB. For the patients who had radio colloid, injection criteria were met for 100%. Pathological evaluation and reporting criteria were met for 100% of patients. There were no axillary recurrences in a median follow up of 35 weeks (IQR 4-60). 7.6% patients had SLN negative on frozen section but positive on final histology. 7.2% of patients with clinical negative nodes had pN2 disease in final histopatholgy report after surgery. 60% of patients who had completion ALND had only positive SLN

Conclusion

With extended indications for SLNB, modification of QIs may be needed. Presently patients eligible for SLNB, including women having mastectomy, T2 or T3 disease, are not covered. In centers where SLN positivity is followed by completion ALND, positive SLNs as the only positive node indicate accuracy of identification, and may be a QI. Although published quality indicators were useful, modification based on local patient characteristics and resource availability may be needed.