Learning and credentialing in breast cancer sentinel lymph node biopsy

The emergence of sentinel lymph node biopsy in breast cancer has provided an alternative to complete axillary lymph node dissection. Discussion and controversy exist as to the proper learning and credentialing criteria that should direct the implementation of this new technology. The techniques and tools for the performance of breast cancer lymphatic mapping are reviewed. The calculation and definition of the false-negative rate are described A description of the instruments to measure and record the learning curve and its relation to surgical volume index is also provided. We conducted a careful review of the extant literature on the subject of learning of learning and credentialing of this new technology. The learning and mastering of the sentinel lymph node biopsy are dependent on the acquisition of skill sets in injection technique, surgical technique, pathologic analysis, and documentation of outcomes data. Method of injection, the number of total procedures performed, and surgical volume index and patient related comorbidities are factors that influence the sentinel lymph node identification and false-negative rates. Learning and credentialing criteria for sentinel lymph node biopsy in breast cancer should mandate that a surgeon perform a minimum of 20 cases with a level I/II completion dissection before performing the sentinel lymph node biopsy alone. Criteria should further mandate an 85% mapping success rate with no more than false-negative result as part of the learning experience. Beyond these criteria, adequacy of surgical mentoring, resident training, and credentialing for this new technology are discussed