Zavagno Giorgio, De Salvo Gian Luca, Casara Dario, Del Bianco Paola, Rubello Domenico, Meggiolaro Fabrizio, Rossi Carlo Riccardo, Pierobon Mariaelena, Lise Mario
University of Padova, Istituto di Clinica Chirurgica II, Padova (35128), Italy.
BMC Cancer. 2004 Jan 22;4:2. doi: 10.1186/1471-2407-4-2.
Although sentinel node biopsy (SNB) is becoming the standard approach for axillary staging in patients with small breast cancer, criteria for patient selection and some technical aspects of the procedure have yet to be clearly defined. The aim of the present survey was therefore to investigate the way in which SNB is used by general surgeons working in the Veneto region, Italy.
A 29-item questionnaire regarding various aspects of SNB practice was mailed to surgeons in charge of breast surgery in all the 56 surgical centres of the region.
The rate of response to the questionnaire was 82.1% (n = 46); 69.6% (n = 32) of the respondents routinely perform SNB in their clinical practice. Most of the interviewed surgeons (93.5%) expressed the belief that the acceptable false negative rate should be < or =5%. However, among the surgeons who perform SNB, only 34.4% performed more than 20 SNB during the learning phase. Indications are limited to tumours of < or =1 cm by 31.2% (n = 10) of respondents, < or =2 cm by 46.9% (n = 15) and < or =3 cm by 21.9% (n = 7). Almost all respondents (93.7%) agreed that a clinically positive axilla is a contraindication to SNB, while opinions differed widely concerning other potential contraindications. In most of the centres considered, SN identification is undertaken on the day before surgery using a subdermal injection of 30-50 MBq of 99mTc-albumin-nanocolloid followed by lymphoscintigraphy.
SNB is currently performed in the majority of hospitals in the Veneto region. However, the training phase and criteria used for patient selection differ from centre to centre. Certified training courses and shared guidelines are therefore highly desirable.
尽管前哨淋巴结活检（SNB）正成为小乳腺癌患者腋窝分期的标准方法，但患者选择标准和该手术的一些技术方面尚未明确界定。因此，本次调查的目的是研究意大利威尼托地区普通外科医生使用SNB的方式。
一份关于SNB实践各个方面的29项问卷被邮寄给该地区56个外科中心负责乳腺手术的外科医生。
问卷回复率为82.1%（n = 46）；69.6%（n = 32）的受访者在临床实践中常规进行SNB。大多数接受采访的外科医生（93.5%）认为可接受的假阴性率应≤5%。然而，在进行SNB的外科医生中，只有34.4%在学习阶段进行了超过20例SNB。31.2%（n = 10）的受访者将适应症限制为肿瘤≤1 cm，46.9%（n = 15）为≤2 cm，21.9%（n = 7）为≤3 cm。几乎所有受访者（93.7%）都同意临床腋窝阳性是SNB的禁忌症，而对于其他潜在禁忌症，意见差异很大。在大多数被考虑的中心，使用皮下注射30 - 50 MBq的99mTc - 白蛋白 - 纳米胶体，随后进行淋巴闪烁显像，在手术前一天进行前哨淋巴结识别。
目前威尼托地区的大多数医院都在进行SNB。然而，各中心的培训阶段和患者选择标准各不相同。因此，非常需要认证培训课程和共享指南。
