Evaluation of implementation of sentinel node biopsy in Australia

Abstract

Background: Sentinel node biopsy (SNB) has been a major change in surgical technique for the management of early breast cancer. In June 2008, the National Breast and Ovarian Cancer Centre (NBOCC) released evidence‐based guidelines for the use of SNB in Australia. During 2010, NBOCC undertook a cohort study to identify the extent to which clinical practice in Australia reflected the recommendations for use of SNB in the 6 months after release of the guidelines. Methods: Records obtained from four datasets, Royal Australasian College of Surgeons National Breast Cancer Audit, New South Wales Central Cancer Registry, Victorian Cancer Registry and Medicare Benefits Schedule records, were analysed to determine the extent to which the four key guideline recommendations had been implemented. This was supplemented by an audit of written SNB protocols of a sample of pathology laboratories in Australia. Results: Across all cohorts, between 78 and 83% of women in Australia with tumours ≤3 cm had an SNB. Data were not available to indicate whether nodes were clinically negative. The likelihood of women having an SNB decreased outside the metropolitan regions, for women treated as public patients compared with private patients and as the size of the tumour increased. In 90% of procedures both preoperative lymphoscintigraphy with isotope and blue dye were used. Conclusion: The findings from the study confirm that best practice recommendations from the NBOCC guidelines for SNB were largely being implemented for women with early breast cancer in Australia within 6 months of their release.

Sentinel node biopsy for early breast cancer in Queensland, Australia, during 2008–2012

“…The uptake of SNB among our ≤30 mm cohort was similar to previously reported rates in Australia and internationally …”

“…The significantly lower SNB uptake among women from less accessibility versus very high accessibility areas was consistent with previously reported lower SNB use for non‐metropolitan women in Australia . Importantly, while SNB usage increased over time across all accessibility categories, there was no evidence for a temporal narrowing of these geographical disparities.…”

“…Despite these recommendations, various studies have reported lower SNB usage among remote and disadvantaged women. However, since none of these studies included women diagnosed after 2008, they provide limited information about the longer term implementation of guidelines …”

Is primary surgery of breast cancer patients consistent with German guidelines? Twelve-year trend of population-based clinical cancer registry data

“…In the USA, the proportion of SLNB was already 27% in 1998 and increased to 66% in 2005 (Chen et al 2008). In Australia, about 80% of the patients underwent SLNB in 2008, which is comparable to the rate from 2010 reported in our study (Morris et al 2012).…”

“…In Australia, about 80% of the patients underwent SLNB in 2008, which is comparable to the rate from 2010 reported in our study (Morris et al . ).…”