Melanoma Institute Australia, North Sydney, NSW, Australia.
Ann Surg Oncol. 2012 Nov;19(12):3919-25. doi: 10.1245/s10434-012-2427-y. Epub 2012 May 30.
There is little literature describing quality assurance (QA) validation of an individual surgeon's ability to perform sentinel node biopsy (SNB) in melanoma patients. This study aims to evaluate incomplete SNB rates and SNB positivity rates as potential QA parameters.
An institutional database identified 2,874 patients with primary melanoma who had SNB performed when there was lymphoscintigraphy drainage to a single lymphatic field. Lymphoscintigraphy data were obtained from another database. Lymphoscintigraphy utilized small-particle colloid, allowing visualization of channels entering sentinel nodes on early dynamic scanning. Incomplete SNB was defined as retrieval of fewer sentinel nodes than identified on lymphoscintigraphy.
The overall rate of incomplete SNB was 17.7 % (including axilla 7.8 %, neck 23.3 %, and groin 28.8 %). Individual surgeons varied significantly in their proportion of SNBs performed in each region (p < 0.001). The surgeons' overall incomplete SNB rate varied significantly (p < 0.001). The surgeons' incomplete SNB rate in the axilla ranged 3-16 % (p < 0.001), median 6 %; groin 21-41 % (p = 0.002), median 26 %; and neck 19-43 % (p = 0.374), median 22 %. The respective axillary, groin, and neck SNB positivity rate for incomplete SNB patients were 10, 23, and 18 % compared to "complete" SNB patients 14, 19, and 14 %. There were no significant differences between surgeons' SNB positivity rates.
Incomplete SNB rates vary between surgeons in each region. SNB positivity rates do not vary commensurate with the incomplete SNB rates. The ranges described could be used as QA parameters, however because none of these experienced surgeons are outliers, the robustness of these parameters remains unproven.
关于个体外科医生行黑色素瘤前哨淋巴结活检（SNB）能力的质量保证（QA）验证，相关文献较少。本研究旨在评估不完全 SNB 率和 SNB 阳性率作为潜在 QA 参数。
通过机构数据库，鉴定出 2874 例行 SNB 的原发性黑色素瘤患者，这些患者的淋巴闪烁显像显示单一淋巴引流区有淋巴液。淋巴闪烁显像数据来源于另一数据库。淋巴闪烁显像采用小颗粒胶体，能在早期动态扫描时显示进入前哨淋巴结的通道。不完全 SNB 定义为 SNB 检出的前哨淋巴结少于淋巴闪烁显像预测的数量。
总体不完全 SNB 率为 17.7%（包括腋窝 7.8%、颈部 23.3%和腹股沟 28.8%）。各个外科医生在各个部位 SNB 检出率上存在显著差异（p<0.001）。外科医生的总体不完全 SNB 率也存在显著差异（p<0.001）。外科医生在腋窝区的不完全 SNB 率为 3-16%（p<0.001），中位数为 6%；腹股沟区为 21-41%（p=0.002），中位数为 26%；颈部为 19-43%（p=0.374），中位数为 22%。不完全 SNB 患者的腋窝、腹股沟和颈部 SNB 阳性率分别为 10%、23%和 18%，而“完全”SNB 患者的相应阳性率分别为 14%、19%和 14%。外科医生的 SNB 阳性率无显著差异。
在每个部位，外科医生之间的不完全 SNB 率存在差异。SNB 阳性率与不完全 SNB 率不一致。描述的范围可以作为 QA 参数，但由于没有一个经验丰富的外科医生是异常值，因此这些参数的稳健性仍有待验证。
