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.
- MeSH
- biopsie sentinelové lymfatické uzliny metody normy MeSH
- delfská metoda MeSH
- dospělí MeSH
- gynekologie metody MeSH
- klinické kompetence MeSH
- konsensus MeSH
- lidé středního věku MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony metody MeSH
- nádory endometria chirurgie MeSH
- průzkumy a dotazníky MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- MeSH
- biopsie sentinelové lymfatické uzliny metody normy MeSH
- dysplazie děložního hrdla chirurgie MeSH
- kongresy jako téma MeSH
- lidé MeSH
- lymfadenektomie metody normy přístrojové vybavení MeSH
- nádory ženských pohlavních orgánů * chirurgie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- novinové články MeSH
OBJECTIVES: Sentinel lymph node (SLN) biopsy can significantly contribute to the management of locally advanced cervical cancers with high risk of lymph node (LN) positivity. However, low detection rate and sensitivity were reported in larger tumors, albeit on a small number of cases. It was the aim of our study to verify the SLN reliability in large tumors, with modified dye application technique and a careful identification of side-specific lymphatic drainage. METHODS: The study involved 44 patients with tumors 3 cm in diameter or larger, stages IB1 to IIA, or selected IIB. In cases where SLN could not be detected, systematic pelvic lymphadenectomy was performed on the respective side. Systematic pelvic lymphadenectomy was performed during the second step radical procedure if not already done. RESULTS: Detection rate in the whole cohort reached 77% per patient and 59% bilaterally. No significant difference was found whether a blue dye or a combined method was used (75% vs 80%, and 55% vs 67%). Systematic pelvic lymphadenectomy was performed in cases with undetected SLN unilaterally in 8 and bilaterally in 10 women. A systematic pelvic lymphadenectomy was included in the second step radical procedure in 19 cases and no positive LN were found. There was no case of false-negative SLN result in patients who underwent surgical treatment. CONCLUSION: Detection rate in locally advanced cervical cancer could be improved by a careful dye application technique. Low false-negative SLN rate could be achieved if pelvic lymphatic drainage is evaluated on a side-specific principle by performing systematic lymphadenectomy if SLN is not detected.
- MeSH
- barvicí látky diagnostické užití MeSH
- biopsie sentinelové lymfatické uzliny metody normy MeSH
- dospělí MeSH
- falešně pozitivní reakce MeSH
- laparoskopie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfadenektomie MeSH
- lymfatické uzliny chirurgie patologie MeSH
- mladý dospělý MeSH
- nádory děložního čípku chirurgie patologie MeSH
- rosanilinová barviva diagnostické užití MeSH
- senioři MeSH
- staging nádorů MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- financování organizované MeSH
Cíl: V chirurgickém léčení časného karcinomu prsu biopsie sentinelové uzliny postupně nahradila disekci axilárních uzlin I. a II. etáže. Cílem studie je ověřit proveditelnost a spolehlivost metody v našich podmínkách. Metoda: V období od června 1998 do června 2007 bylo provedeno 458 biopsií sentinelové uzliny (SLNB). Ke značení uzlin byla nejdříve použita Patentblue a od roku 2000 kombinace radiokoloidu s gama sondou a Patentblue. Po SLNB následovala vždy disekce axily, od které bylo upuštěno u negativních sentinelových uzlin v roce 2002. Výsledky: Z celkového počtu 458 SLNB bylo do souboru zařazeno 382 pacientek. Pouze SLNB bez současné disekce axily byla provedena 170x. V 70 případech byla sentinelová uzlina pozitivní a následovala disekce axily. Non-sentinelové uzliny byly pozitivní 17x. Celkem bylo v základním souboru 382 biopsií vyšetřeno 899 sentinelových uzlin. Průměr byl 2,35. Falešně negativní uzliny byly zaznamenány u pacientek se SLNB a následnou disekcí axily 3x (4,6 %.) Nebyla registrována lokální recidiva v axile u negativní sentinelové uzliny bez následné disekce axily. Závěr: Biopsie sentinelové uzliny je bezpečná alternativa axilární disekce v chirurgické léčbě časného karcinomu prsu.
Aim: In the management of early breast carcinoma, biopsy of sentinel lymph nodes has gradually replaced dissection of Level I and II axillary nodes. The aim of the study is to assess feasability and reliability of the method in our conditions. Method: From June 1998 to June 2007, a total of 458 sentinel node biopsies (SLNB) were performed. Originally, patent blue sentinel node mapping was used. Since 2000, a combination of radiocolloid application and a gamma- probe (detector), as well as the patent blue, has been used. Originally, SLNBs were followed by axillary dissections, however, in 2002, the procedure was waived in cases of negative sentinel nodes findings. Results: Out of the total of 458 SLNB patients, 382 female patients were included in the study. SLNB, without concomitant axillary dissection, was performed in 170 subjects. In 70 subjects, the sentinel node was positive and they were indicated for axillary dissections. Positive non-sentinel nodes were detected 17 times. In total, 899 sentinel nodes were examined in the study group of 382 biopsies. The mean was 2.35. False negative nodes were recorded in three cases in female patients with SLNB and axillary dissection (4.6%). No local relapses in the axilla were recorded in negative sentinel node findings without subsequent axillary dissections. Conclusion: Sentinel node biopsy is a safe alternative to axillary dissection in the surgical management of early breast carcinoma.
- MeSH
- axila chirurgie MeSH
- biopsie sentinelové lymfatické uzliny metody normy MeSH
- lidé MeSH
- lymfadenektomie metody normy MeSH
- mamoplastika etika kontraindikace metody MeSH
- mastektomie metody MeSH
- nádory prsu * chirurgie patologie MeSH
- radikální mastektomie metody MeSH
- segmentální mastektomie kontraindikace metody MeSH
- subkutánní mastektomie metody MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- MeSH
- axila chirurgie patologie MeSH
- biopsie sentinelové lymfatické uzliny metody normy využití MeSH
- chirurgie operační metody využití MeSH
- lékařská onkologie metody trendy MeSH
- lidé MeSH
- lymfadenektomie metody využití MeSH
- lymfatické metastázy diagnóza MeSH
- nádory prsu diagnóza chirurgie MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- staging nádorů metody využití MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
