Correspondence and Brief Communications |

The Learning Curve for Sentinel Lymph Node Biopsy in Breast Cancer

Richard K. Orr, MD, MPH
Arch Surg. 2000;135(5):605-606. doi:.
Text Size: A A A
Published online


In reply

I find it interesting that Dr Cody criticizes most of the assumptions of our article, yet agrees with its conclusion that surgeons should perform full axillary dissection until they have ascended the "learning curve" for sentinel node biopsy. Hopefully, I can mollify some of Cody's concerns.

Failure to Identify Sentinel Nodes. At the time our article1 was submitted, the 17 published studies (Table 1 in our article) included only 9 (53%) in which sentinel nodes were identified in 90% or more patients. These series included the surgeons' early and later operative experience. Only 6 of these series listed 50 or fewer patients, and in those 6, sentinel nodes were identified 66% to 92% of the time (weighted average, 86%). I suspect that the occasional operator, especially in institutions without good nuclear medicine support, will perform at a level closer to the early experience cited in our article (references 5 and 7) than the later publications described by Cody. A recent publication from a multidisciplinary breast center (with good support) noted that the sentinel node was identified in 73% of their first 44 cases.2

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles