Troubleshooting Sentinel Lymph Node Biopsy in Breast Cancer Surgery

Abstract

Purpose Performing a sentinel lymph node biopsy (SLNB) is the standard of care for axillary nodal staging in patients with invasive breast cancer and clinically negative nodes. The procedure provides valuable staging information with few complications when performed by experienced surgeons. However, variation in proficiency exists for this procedure, and a great amount of experience is required to master the technique, especially when faced with challenging cases. The purpose of this paper is to provide a troubleshooting guide for commonly encountered technical difficulties in SLNB, and offer potential solutions so that surgeons can improve their own technical performance from the collective knowledge of experienced specialists in the field. Methods Information was obtained from a convenience sample of six experienced breast cancer specialists, each actively involved in training surgeons and residents/fellows in SLNB. Each surgeon responded to a structured interview in order to provide salient points of the SLNB procedure. Results Four of the key opinion surgical specialists provided their perspective using technetium-99m sulfur colloid, and two shared their experience using blue dye only. Distinct categories of commonly encountered problem scenarios were presented and agreed upon by the panel of surgeons. The responses to each of these scenarios were collected and organized into a troubleshooting guide. Discussion We present a compilation of “tips” organized as a troubleshooting guide to be used to guide surgeons of varying levels of experience when encountering technical difficulties with SLNB.

New techniques for sentinel node biopsy in breast cancer

“…James et al (10) accurately described best practices for both of these tracers besides to the main problems linked to them.…”

A novel enhanced intensity‐based automatic registration: Augmented reality for visualization and localization cancer tumors

“…Here, a wire is inserted until its tip reaches the tumor, as indicated by an MRI, mammogram or ultrasound. The wire serves as a guide for the surgeon in determining the section of the breast/s to be removed . The drawback of this traditional method is that it must be conducted during the surgery; consequently, surgeons cannot plan for the surgery insofar as deciding a priori which section of the breast to remove.…”

“…Breast cancer is typically treated by removing the tumor and cancer tissue. 1 In order to conduct this surgery, medical professionals must first determine tumor location. This step is commonly achieved by using wire localization techniques.…”

“…The wire serves as a guide for the surgeon in determining the section of the breast/s to be removed. 1 The drawback of this traditional method is that it must be conducted during the surgery; consequently, surgeons cannot plan for the surgery insofar as deciding a priori which section of the breast to remove. Resultantly, the risk to the patient, and surgery length, may be higher than is necessary.…”

Preoperative localization of sentinel lymph node in breast cancer patients by silver wire insertion or liquid charcoal injection guided by CT lymphography

“…Detection of SLN is performed intraoperative commonly either using dye, radioisotope, or dual approach, with highest accuracy on using dual approach . However, detection of SLN depends, after the localization method, on the surgeon's experience & proficiency as many cases are required for mastering the technique for intraoperative detection of SLN …”