Institutional learning curves for performance of sentinel node biopsy (SNB) have previously been studied, but no distinction has been possible between surgical and institutional curves. The goal of this study was to assess the specific institutional learning curve for SNB in a community hospital implementing this technique. Upon implementation of SNB in a community hospital, backup axillary dissection was performed. The surgeon had extensive experience prior to the study. The SNB was performed with technetium sulfur colloid injected within 24 hours and Patent Blue dye injected within 30 minutes of the skin incision. Two learning curves were derived: one depicting identification failures in relation to the cumulative number of procedures performed by the community hospital team and one showing the false-negative rate in relation to the total number of cases with nodal metastasis. Fifty-nine patients were enrolled in this study. Sentinel node(s) were identified in 57 patients (96.6%), yielding an overall failure rate of 3.4%. In this study, no specific institutional learning curve was identified for SNB. In a well-controlled and carefully designed implementation process, an experienced surgeon can build a new collaborative team for SNB and can rapidly achieve very good results.
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