Skip to main content

Advertisement

SpringerLink
Log in

Beyond the False Negative Rate: Development of Quality Indicators for Sentinel Lymph Node Biopsy in Breast Cancer

  • Translational Research and Biomarkers
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Sentinel lymph node biopsy (SNLB) has been adopted as the standard method of axillary staging for women with clinically node-negative early-stage breast cancer. The false negative rate as a quality indicator is impractical given the need for a completion axillary dissection to calculate. The objective of this study was to develop practical quality indicators for SLNB using an expert consensus method and to determine if they were feasible to measure.

Materials and Methods

We used a modified Delphi consensus process to develop quality indicators for SLNB. A multidisciplinary expert panel reviewed potential indicators extracted from the medical literature to select quality indicators that were relevant and measurable. Feasibility was determined by abstracting the quality indicator variables from a retrospective chart review.

Results

The expert panel prioritized 11 quality indicators as benchmarks for assessing the quality of surgical care in SNLB. Nine of the indicators were measurable at the chart or institutional level.

Conclusions

A systematic evidence- and consensus-based approach was used to develop measurable quality indicators that could be used by practicing surgeons and administrators to evaluate performance of SLNB in breast cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Campbell SM, Roland MO, Buetow SA. Defining quality of care. Soc Sci Med. 2000;51(11):1611–25.

    Article  CAS  PubMed  Google Scholar 

  2. Blumenthal D. Part 1: quality of care—what is it? N Engl J Med. 1996;335:891–4.

    Article  CAS  PubMed  Google Scholar 

  3. Hewitt M. Ensuring quality cancer care. Washington, DC: National Academy Press; 1999, p. 246.

    Google Scholar 

  4. Mansfield L, Sosa I, Dionello R, Subramanian A, Devalia H, Mokbel K. Current management of the axilla in patients with clinically node-negative breast cancer: a nationwide survey of United Kingdom breast surgeons. Int Semin Surg Oncol. 2007;4:4.

    Article  PubMed  Google Scholar 

  5. Lyman GH, Giuliano AE, Somerfield MR, Benson AB III, Bodurka DC, Burstein HJ, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23(30):7703–20.

    Article  PubMed  Google Scholar 

  6. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: Breast Cancer V2.2007 [Online]. http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf. [10/24 2007].

  7. American Society of Breast Surgeons. Consensus statement on guidelines for performing sentinel lymph node dissection in breast cancer; 2006.

  8. Gagliardi AR, Fleshner N, Langer B, Stern H, Brown AD. Development of prostate cancer quality indicators: a modified Delphi approach. Can J Urol. 2005;12(5):2808–15.

    PubMed  Google Scholar 

  9. Gagliardi AR, Fung MF, Langer B, Stern H, Brown AD. Development of ovarian cancer surgery quality indicators using a modified Delphi approach. Gynecol Oncol. 2005;97(2):446–56.

    Article  PubMed  Google Scholar 

  10. Gagliardi AR, Simunovic M, Langer B, Stern H, Brown AD. Development of quality indicators for colorectal cancer surgery, using a 3-step modified Delphi approach. Can J Surg. 2005;48(6):441–52.

    PubMed  Google Scholar 

  11. Malin JL, Asch SM, Kerr EA, McGlynn EA. Evaluating the quality of cancer care: development of cancer quality indicators for a global quality assessment tool. Cancer. 2000;88(3):701–7.

    Article  CAS  PubMed  Google Scholar 

  12. Quan ML. Treatment of ductal carcinoma in situ (DCIS): evaluation of a multidisciplinary disease specific approach. Unpublished Masters thesis, University of Calgary, 2005.

  13. Fitch K, Bernstein SJ, Aguilar MD, Burnand B, LaCalle JR, Lazaro P, et al. The RAND/UCLA appropriateness method user’s manual. RAND Europe, RAND Health 126; 2001.

  14. ASCO/NCCN Quality Measures: Breast and Colorectal Cancers. American Society of Clinical Oncology and National Comprehensive Cancer Network; 2007.

  15. Schachter HM, Mamaladze V, Lewin G, Graham ID, Brouwers M, Sampson M, et al. Many quality measurements, but few quality measures assessing the quality of breast cancer care in women: a systematic review. BMC Cancer. 2006;6:291.

    Article  PubMed  Google Scholar 

  16. Desch CE, McNiff KK, Schneider EC, Schrag D, McClure J, Lepisto E, et al. American Society of Clinical Oncology/National comprehensive cancer network quality measures. J Clin Oncol. 2008;26(21):3631–7.

    Article  PubMed  Google Scholar 

  17. Krag DN, Julian TB, Harlow SP, Weaver DL, Ashikaga T, Bryant J, et al. NSABP-32: Phase III, randomized trial comparing axillary resection with sentinel lymph node dissection: a description of the trial. Ann Surg Oncol. 2004;11(3):208S–10S.

    PubMed  Google Scholar 

  18. White RL Jr, Wilke LG. Update on the NSABP and ACOSOG breast cancer sentinel node trials. Am Surg. 2004;70(5):420–4.

    PubMed  Google Scholar 

  19. Cantin J, Scarth H, Levine M, Hugi M, Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Clinical practice guidelines for the care and treatment of breast cancer: 13. Sentinel lymph node biopsy. CMAJ. 2001;165(2):166–73.

    CAS  PubMed  Google Scholar 

  20. Schwartz GF, Giuliano AE, Veronesi U, Consensus Conference Committee. Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19–22, 2001, Philadelphia, PA. Cancer. 2002; 94(10):2542–51.

    Google Scholar 

  21. Clarke D, Newcombe RG, Mansel RE, ALMANAC Trialists Group. The learning curve in sentinel node biopsy: the ALMANAC experience. Ann Surg Oncol. 2004;11(3):211S–5S.

    PubMed  Google Scholar 

  22. Harlow SP, Krag DN, Julian TB, Ashikaga T, Weaver DL, Feldman SA. Prerandomization surgical training for the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-32 trial: a randomized phase III clinical trial to compare sentinel node resection to conventional axillary dissection in clinically node-negative breast cancer. Ann Surg. 2005;241(1):48–54.

    PubMed  Google Scholar 

  23. Quan ML, Hodgson N, Lovrics PJ, Porter GA, Poirer B, Wright FC. National adoption of sentinel node biopsy for breast cancer: Lessons learned from the Canadian experience. Breast J. 2008;14:421–7.

    Article  PubMed  Google Scholar 

  24. Lucci A Jr, Kelemen PR, Miller C III, Chardkoff L, Wilson L. National practice patterns of sentinel lymph node dissection for breast carcinoma. J Am Coll Surg. 2001;192(4):453–8.

    Article  PubMed  Google Scholar 

  25. Campbell SM, Hann M, Roland MO, Quayle JA, Shekelle PG. The effect of panel membership and feedback on ratings in a two-round Delphi survey: results of a randomized controlled trial. Med Care. 1999;37(9):964–8.

    Article  CAS  PubMed  Google Scholar 

  26. Leape LL, Park RE, Kahan JP, Brook RH. Group judgments of appropriateness: the effect of panel composition. Qual Assur Health Care. 1992;4(2):151–9.

    CAS  PubMed  Google Scholar 

  27. Kahan JP, Park RE, Leape LL, Bernstein SJ, Hilborne LH, Parker L. Variations by specialty in physician ratings of the appropriateness and necessity of indications for procedures. Med Care. 1996;34(6):512–23.

    Article  CAS  PubMed  Google Scholar 

  28. O’Malley AS, Clancy C, Thompson J, Korabathina R, Meyer GS. Clinical practice guidelines and performance indicators as related–but often misunderstood-tools. Jt Comm J Qual Saf. 2004;30(3):163–71.

    PubMed  Google Scholar 

  29. Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Ashikaga T. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol. 2007;8(10):881–8.

    Article  CAS  PubMed  Google Scholar 

  30. Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst. 2006;98(9):599–609.

    Article  PubMed  Google Scholar 

  31. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233–41.

    Article  PubMed  Google Scholar 

  32. Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol. 2006;7(12):983–90.

    Article  PubMed  Google Scholar 

  33. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227–32.

    Article  PubMed  Google Scholar 

  34. Helyer LK, Coburn NG, Law CH, McCready DR. Does the adoption of sentinel node biopsy account for the increase in node positivity in women with T1 tumors? Ann Surg Oncol. 2008;15:75.

    Google Scholar 

Download references

Acknowledgment

This research was made possible by the generous grants from the Canadian Breast Cancer Research Alliance and the Canadian Breast Cancer Foundation, Ontario Chapter. We are also very appreciative of the time and contributions of the expert panel (Appendix, Table 7).

Author information

Authors and Affiliations

  1. Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    May Lynn Quan MD, MSc, Bryan J. Wells MD, Frances C. Wright MD, MEd, Novlette Fraser MA & Anna R. Gagliardi PhD

  2. Department of Surgery, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada

    David McCready MD, MSc

Authors
  1. May Lynn Quan MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bryan J. Wells MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David McCready MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Frances C. Wright MD, MEd
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Novlette Fraser MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anna R. Gagliardi PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to May Lynn Quan MD, MSc.

Appendix

Appendix

See Tables 5, 6, 7

Table 5 Search strategy for candidate quality indicators for sentinel lymph node biopsies in breast cancer (Database: Ovid MEDLINE [1996 to July Week 1 2007])
Full size table
Table 6 Literature review search results by source of evidence
Full size table
Table 7 Sentinel lymph node biopsy nominated expert panel
Full size table

Rights and permissions

Reprints and permissions

About this article

Cite this article

Quan, M.L., Wells, B.J., McCready, D. et al. Beyond the False Negative Rate: Development of Quality Indicators for Sentinel Lymph Node Biopsy in Breast Cancer. Ann Surg Oncol 17, 579–591 (2010). https://doi.org/10.1245/s10434-009-0658-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-009-0658-3

Keywords

Search

Navigation