INTRODUCTION: Sentinel lymph node dissection is widely used in the staging of endometrial cancer. Variation in surgical techniques potentially impacts diagnostic accuracy and oncologic outcomes, and poses barriers to the comparison of outcomes across institutions or clinical trial sites. Standardization of surgical technique and surgical quality assessment tools are critical to the conduct of clinical trials. By identifying mandatory and prohibited steps of sentinel lymph node (SLN) dissection in endometrial cancer, the purpose of this study was to develop and validate a competency assessment tool for use in surgical quality assurance. METHODS: A Delphi methodology was applied, included 35 expert gynecological oncology surgeons from 16 countries. Interviews identified key steps and tasks which were rated mandatory, optional, or prohibited using questionnaires. Using the surgical steps for which consensus was achieved, a competency assessment tool was developed and subjected to assessments of validity and reliability. RESULTS: Seventy percent consensus agreement standardized the specific mandatory, optional, and prohibited steps of SLN dissection for endometrial cancer and informed the development of a competency assessment tool. Consensus agreement identified 21 mandatory and three prohibited steps to complete a SLN dissection. The competency assessment tool was used to rate surgical quality in three preselected videos, demonstrating clear separation in the rating of the skill level displayed with mean skills summary scores differing significantly between the three videos (F score=89.4; P<0.001). Internal consistency of the items was high (Cronbach α=0.88). CONCLUSION: Specific mandatory and prohibited steps of SLN dissection in endometrial cancer have been identified and validated based on consensus among a large number of international experts. A competency assessment tool is now available and can be used for surgeon selection in clinical trials and for ongoing, prospective quality assurance in routine clinical care.

Center for Clinical Research Faculty of Medicine University of Queensland Herston Queensland Australia

Centre for Health Services Research The University of Queensland Faculty of Medicine Brisbane Queensland Australia

Clinical Sciences Obstetrics and Gynaecology Lund University Faculty of Medicine Lund Sweden

Department of Obstetrics and Gynecology Università degli Studi Milano Bicocca San Gerardo Hospital Monza Italy

Division of Gynecologic Oncology Italy Ospedale Michele e Pietro Ferrero Verduno Italy

Faculty of Medicine The University of Queensland St Lucia Queensland Australia

Gynaecologic Oncology Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy

Gynaecologic Oncology John Hunter Hospital New Lambton Heights New South Wales Australia

Gynaecologic Oncology Mater Health Services Brisbane South Brisbane Queensland Australia

Gynaecologic Oncology National University Health System Singapore

Gynaecologic Oncology Royal Brisbane and Women's Hospital Herston Queensland Australia

Gynaecological Oncology Mercy Hospital for Women Heidelberg Victoria Australia

Gynaecological Oncology Royal Brisbane and Women's Hospital Herston Queensland Australia

Gynaecological Oncology Royal Marsden NHS Foundation Trust London UK

Gynaecology Oncology Mater Misericordiae University Hospital Dublin Ireland

Gynaecology St George's University of London London UK

Gynecologic Oncology and Reproductive Medicine The University of Texas MD Anderson Cancer Center Houston Texas USA

Gynecologic Oncology CancerCare Manitoba Winnipeg Manitoba Canada

Gynecologic Oncology Clínica De Oncología Astorga Medellín Colombia

Gynecologic Oncology Instituto Nacional de Cancerologia Bogota Colombia

Gynecologic Oncology University Health Network Toronto Ontario Canada

Gynecologic Oncology University of Manitoba Winnipeg Manitoba Canada

Gynecologic Surgery Department of Obstetrics and Gynecology Mayo Clinic Rochester Rochester Minnesota USA

Gynecology and Obstetrics Charles University 1st Faculty of Medicine Praha Praha Czech Republic

Gynecology and Obstetrics General University Hospital Prague Praha Czech Republic

Gynecology and Obstetrics Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital Shanghai China

Gynecology and Obstetrics University of Essen Essen Germany

Gynecology Leiden University Medical Center Leiden Zuid Holland The Netherlands

Gynecology Oncology Hospital Clinico San Borja Arriaran Santiago Chile

Gynecology Oncology Hospital General San Juan de Dios Guatemala Guatemala

Gynecology Oncology Service Centre Hospitalier Universitaire de Québec Université Laval Quebec Quebec Canada

Gynecology Oncology Universidad de Chile Santiago de Chile Chile

Gynecology Oncology University of San Carlos de Guatemala Faculty of Medical Sciences Guatemala Guatemala

Gynecology Service Department of Surgery Memorial Sloan Kettering Cancer Center New York New York USA

Obstetrics and Gynaecology National University of Singapore Singapore

Obstetrics and Gynaecology Royal Women's Hospital Parkville Victoria Australia

Obstetrics and Gynaecology Skanes Universitetssjukhus Lund Lund Skåne Sweden

Obstetrics and Gynaecology The University of Western Australia Faculty of Health and Medical Sciences Perth Western Australia Australia

Obstetrics and Gynaecology University of Hong Kong Li Ka Shing Faculty of Medicine Hong Kong Hong Kong

Obstetrics and Gynaecology University of Toronto Toronto Ontario Canada

Obstetrics and Gynecology The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA

Queensland Centre for Gynaecologic Cancer Research Royal Brisbane and Women's Hospital Herston Queensland Australia

School of Medicine University College Dublin Dublin Ireland

Surgery and Cancer Imperial College London London UK

Surgical Oncology Department for Breast and Gynecology Universite de Paris Paris Île de France France

Surgical Oncology Institute Curie Paris France

Victorian Comprehensive Cancer Centre University of Melbourne Parkville Victoria Australia

Women's and Children's Health Karolinska Institute Stockholm Sweden

Women's and Children's Health Karolinska University Hospital Stockholm Sweden

Int J Gynecol Cancer. 2021 May;31(5):656-657. doi: 10.1136/ijgc-2021-002607. PubMed

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