Clarke Dayalan, Newcombe Robert G, Mansel Robert E
University Department of Surgery, University of Wales College of Medicine, Heath Park, Cardiff, United Kingdom.
Ann Surg Oncol. 2004 Mar;11(3 Suppl):211S-5S. doi: 10.1007/BF02523631.
Sentinel node biopsy (SNB) is a minimally invasive procedure to stage the axilla in patients with breast cancer. Like any new surgical procedure, it is associated with a learning curve. This article describes the learning curve as part of the ALMANAC trial. The first phase of this trial is a validation phase in which surgeons perform SNB followed by an immediate axillary dissection in a consecutive series of 40 patients with invasive breast cancer. Each surgeon completes a mandatory program of proctored training during this phase. Surgeons who achieve a localization rate of 90% or more and a false-negative rate of 5% or less are eligible to proceed to the randomized phase. All 13 surgeons who completed 40 procedures as part of the validation phase of the ALMANAC trial achieved the set target. This study shows that a standardized training program allows surgeons to achieve a satisfactory localization rate and an acceptable false-negative rate after 40 SNBs.
前哨淋巴结活检（SNB）是一种用于对乳腺癌患者腋窝进行分期的微创手术。与任何新的外科手术一样，它存在学习曲线。本文将学习曲线作为ALMANAC试验的一部分进行描述。该试验的第一阶段是验证阶段，在此阶段，外科医生对40例浸润性乳腺癌患者连续进行前哨淋巴结活检，随后立即进行腋窝清扫。在此阶段，每位外科医生都要完成一个强制性的导师指导培训项目。定位率达到90%或更高且假阴性率为5%或更低的外科医生才有资格进入随机分组阶段。作为ALMANAC试验验证阶段一部分完成40例手术的所有13位外科医生均达到了设定目标。这项研究表明，标准化培训项目能使外科医生在进行40例前哨淋巴结活检后达到令人满意的定位率和可接受的假阴性率。
