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The learning curve in sentinel node biopsy(SNB) in breast cancer: results from the ALMANAC trial [Abstract]

Clarke, D. and Mansel, Robert Edward 2001. The learning curve in sentinel node biopsy(SNB) in breast cancer: results from the ALMANAC trial [Abstract]. Breast Cancer Research and Treatment 69 (3) , p. 212.

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Introduction: Sentinel node biopsy(SNB)holds the promise of becoming the surgical procedure of choice in the accurate staging of the axilla. As with any other new surgical rechnique, there is a learning curve associated with this new surgical technique. The ALMANAC trial (Axillary Lymphatic Mapping Against Nodal Axillary Clearance) is the only randomised trial of SNB in breast cancer that has incorporated an audit phase within the structure of the trial, to give allowance for a learning curve, prior to the randomised phase. Methods: ALMANAC is a two phased, multi-centre, randomised trial currently in progress in the UK. The first phase or audit phase, comprised each surgeon performing a SNB followed by an axillary sampling or clearance in 40 patients with invasive breast cancer. The sentinel node was identified by a combination method of a radiopharmaceutical (nanocol) injected around the tumour, followed by a lymphoscintiscan around 3 hours later, peroperative patent blue V and a hand held gamma probe. All surgeons participating in the trial attended a training course and were additionally proctored in their own institution by the principal investigator of the trial (R E Mansel). Results: The trial protocol required each surgeon to achieve a successful localisation rate of 90% and a false negative rate of 5% in the audit phase to be able to proceed to the randomised phase. In the audit phase 400 patients had a SNB followed by axillary surgery, performed by 10 surgeons. The localisation rate of the sentinel node was 96.6% and the false negative rate was 5%. All 10 surgeons met the criteria and have since progressed to the randomised phase. The learning curves of the individual surgeons will be presented. Conclusions: We conclude from our results that if surgeons are adequately trained and proctored in this new surgical technique, as has been done in the ALMANAC trial, the failed localisation and false negative rates can be reduced to safely acceptable levels.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
Additional Information: Abstract Issue, 24th Annual San Antonio, Breast Cancer Symposium. December 10-13, 2001 San Antonio Marriott Rivercenter, Texas, USA.
Publisher: Springer Verlag
ISSN: 0167-6806
Related URLs:
Last Modified: 04 Jun 2017 04:44

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