Measuring the Quality of Sentinel Lymph Node Biopsy in Breast Cancer Using Newly Developed Quality Indicators: A Feasibility Study

Bryan J. Wells MD, MSc, Hesham Najjar MD, Frances C. Wright MD, MEd, Claire M. B. Holloway MD, PhD, Novlette Fraser MA, David McCready MD, MSc, May Lynn Quan MD, MSc
Breast Oncology
Volume 18, Issue 1 / January , 2010

View full article HTML | View full article PDF | Download Citation

Abstract

Background

Measurement of the quality of sentinel lymph node biopsy (SLNB) has not been reported beyond the false-negative rate and sentinel lymph node identification rate. This study’s purpose is to determine the feasibility of measuring 11 quality indicators (QIs) that were recently developed using a modified Delphi process.

Methods

All patients who underwent SLNB for breast cancer at a tertiary health-care center from January 1st 2005 to December 31st 2007 were identified using a SLNB registry. Patient charts were reviewed retrospectively and the QIs were abstracted.

Results

Nine of the 11 QIs were measurable: 7 required chart-level abstraction, 2 were confirmed at an institutional level, and 2 were immeasurable due to registry limitations. Of the 497 identified patients, 13 patients had failed SLNB, resulting in 484 SLNBs. The axillary positivity rate was 19%. The method of SLN identification was reported in 97% of cases, and in 388 (80%) more than one SLN was removed. All SLNs were serially sectioned according to protocol, though only 102 (21%) of pathology reports explicitly stated the cancer stage. Nearly all SLNBs were performed alongside the primary breast surgery. Among SLN-positive patients: 78 (87%) underwent axillary lymph node dissection, 10 patients refused, and chart data were missing in 2 others. No “ineligible” patients had SLNB.

Conclusion

Measurement of newly developed QIs for SLNB is feasible for abstraction from inpatient charts at a single institution. These QIs can provide baseline measures for ongoing quality assessment of SLNB using hospital chart review.

Go to Issue Contents