Quan May Lynn, Hodgson Nicole, Lovrics Peter, Porter Geoff, Poirier Brigitte, Wright Frances C
Division of Surgical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
Breast J. 2008 Sep-Oct;14(5):421-7. doi: 10.1111/j.1524-4741.2008.00617.x. Epub 2008 Jul 24.
Sentinel lymph node biopsy (SLNB) in breast cancer has not been readily adopted into Canadian surgical practice in comparison with the United States. We sought to evaluate current national practice patterns and explore barriers to direct efforts to improve the adoption of SLNB in Canada. All active (n = 1413) general surgeons in Canada were surveyed by mail. Surgeon demographics, practice patterns, skill acquisition and attitudes towards SLNB were assessed. The response rate was 63% (n = 889). Of the 506 (57%) surgeons who treated breast cancer, half were community based with breast surgery comprising <25% of their practices. Most (70%) performed <or=5 breast surgeries/month. Almost all (96%) believed SLNB was standard of care or an acceptable alternative to axillary lymph node dissection (ALND). Of these, 306 (61%) performed SLNB. Predictors of performing SLNB were breast/oncology fellowship (p = 0.03) or greater percentage of practice dedicated to breast (p = 0.02) but not region, type of practice (community versus academic), gender or year of residency completion. Reasons for performing SLNB were decreased morbidity (85%) and enhanced staging (59%) as opposed to competitive pressure (13%). The majority (75%) performed SLNB as a stand-alone procedure for T1/T2 cancers and high-risk ductal carcinoma in situ (70%). Almost half (46%) abandoned back up ALND after 30 or fewer cases even though the majority (75%) acknowledged the false-negative rate should be <5%. Most (76%) learned SLNB through mentoring or a formal course/residency. Of the 197 (39%) not performing SLNB, 53% felt that inadequate access to nuclear medicine and gamma probe equipment was the predominant barrier. SLNB has been adopted into Canadian surgical practice. The majority of surgeons believe that SLNB is an acceptable alternative to ALND, with 61% now performing SLNB compared to 27% in 2001. Barriers to implementation appear to be related to inadequate resources as opposed to lack of belief in the procedure.
与美国相比，前哨淋巴结活检（SLNB）在加拿大外科手术实践中尚未得到广泛应用。我们试图评估当前全国的实践模式，并探索直接努力改善加拿大SLNB应用情况的障碍。通过邮件对加拿大所有在职的（n = 1413）普通外科医生进行了调查。评估了外科医生的人口统计学特征、实践模式、技能获取情况以及对SLNB的态度。回复率为63%（n = 889）。在506名（57%）治疗乳腺癌的外科医生中，一半是社区医生，其乳腺手术占其业务量的比例不到25%。大多数（70%）医生每月进行的乳腺手术≤5例。几乎所有（96%）医生认为SLNB是护理标准或腋窝淋巴结清扫术（ALND）的可接受替代方法。其中，306名（61%）医生进行SLNB。进行SLNB的预测因素是乳腺/肿瘤学 fellowship（p = 0.03）或从事乳腺相关业务的比例更高（p = 0.02），但与地区、实践类型（社区与学术）、性别或完成住院医师培训的年份无关。进行SLNB的原因是发病率降低（85%）和分期改善（59%），而非竞争压力（13%）。大多数（75%）医生将SLNB作为T1/T2期癌症和高危导管原位癌的独立手术（70%）。即使大多数（75%）医生承认假阴性率应＜5%，几乎一半（46%）医生在30例或更少病例后就放弃了备用的ALND。大多数（76%）医生通过导师指导或正式课程/住院医师培训学习SLNB。在197名（39%）未进行SLNB的医生中，53%认为获取核医学和伽马探针设备不足是主要障碍。SLNB已被纳入加拿大外科手术实践。大多数外科医生认为SLNB是ALND的可接受替代方法，与2001年的27%相比，现在有61%的医生进行SLNB。实施的障碍似乎与资源不足有关，而非对该手术缺乏信心。
