Learning curve

The data show that there is a definite learning curve for sentinel node biopsy that cannot be ignored (13-15). The ALMANAC study group has shown that standardised training programme of in-house proctored operative training can decrease the learning curve. The surgeon's first procedure is at higher risk of failure (especially a false negative, than subsequent ones (16). The number of procedures of the learning curve cannot be fixed for all surgeons. It has been suggested that surgeons should attend a formal course on SLNB technique and perform a minimum of 20-30 SLNB procedures in combination with axillary lymph node dissection (ALND) or with mentoring to reduce the risk of false-negative results. In the UK, a national sentinel lymph node biopsy (SLNB) training programme, NEW START, was launched in October 2004. This unique surgical educational programme provides structured, multiprofessional, regional (and local) training in SLNB, supported by high quality educational DVD. The programme consists of:

• A theory day: lectures, discussions, and hands-on training models

• In-house proctoring: first 5 cases - SLNB with standard axillary procedure

• Validation phase: further 25 cases - SLNB with standard axillary procedure

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