Suggested issues for improvement in sentinel lymph node biopsy quality indicators
| Quality indicator | Comments/suggestions |
|---|---|
| Pathologic evaluation protocol | Prerequisite, but does not speak of the surgeon’s skill. |
| Pathologic reporting by AJCC guidelines | Prerequisite, but does not speak of the surgeon’s skill. |
| Protocol for injection of radiocolloid | Prerequisite, but does not speak of the surgeon’s skill. |
| Proper identification of SLN | No changes necessary. |
| SLNB performance in eligible patients | Target rates should be redefined. Preoperative assessment of axilla by MRI and ultrasound can decrease the number of eligible patients. Patients other than those with T1 tumours should be included (e.g., T2, T3). |
| SLNB concurrent with lumpectomy/mastectomy | Lack of strong evidence against nonconcurrent breast primary surgery and axillary staging procedure. |
| Completion ALND for positive SLNB | Requires redefinition given the fact there is evidence that ALND can be avoided patients with micrometastasis and isolated tumour cells. |
| SLNB performance in ineligible patients | Better definition of ineligible patients is necessary. |
| Axillary node positivity rate | No changes necessary. |
| Number of nodes removed | Requires an upper limit to the target rate. |
| Axillary recurrence rate at 5 years | No changes necessary. |
AJCC = American Joint Committee on Cancer; ALND = axillary lymph node dissection; MRI = magnetic resonance imaging; SLN = sentinel lymph node; SLNB = sentinel lymph node biopsy.