Localizing the sentinel node outside of the specialty center: Success of a lymphatic mapping course in disseminating new technology

Background: Sentinel node biopsy (SNB) is an evolving technology in the management of breast cancer. The purpose of this study was to determine the success of an SNB course in emphasizing principles fur participants to successfully initiate an SNB program at their institution. Methods: Participants in a university-sponsored course were queried 6 to 18 months after the course regarding their success in initiating SNB in their practice. Univariate analysis was used to determine the likelihood of implementing a SNB program. Results: Ninety-one participants responded. Of these respondents, 56 had initiated an SNB program at their hospital, and 20 had completed a "validation" phase. "Validation" consisted of less than 10 cases for 11 respondents, 11 to 20 cases for 5 respondents, and 20 to 30 cases for 3 respondents and >30 cases for 1 respondent. Twenty-eight percent initiated the learning curve without an institutional Review Board (IRB) protocol, and a further 20% went on to utilize SNB without axillary dissection in sentinel node-negative patients without IRE approval. Univariate analysis revealed that surgeons practicing in a group whose caseload consisted of more than 25% breast surgery cases were most likely (P < 0.05) to implement SNB in their practice. Conclusions: Success in applying SNB after a course is high among surgeons in groups with a significant breast caseload, although recommendations for obtaining institutional approval and completing a 30-case validation series are often disregarded.