August 11, 2017
Sentinel Node Biopsy (SNB) Training Programme
SNB is a procedure that is very operator sensitive. It is evident that new operators have a higher error rate when they start which decreases as they gain experience. As we introduce SNB across the UK, we are attempting to do so such a way as to keep the error rate low across all hospitals adopting the procedure through our extensive training programme.
The training consists of three components: initial lectures, procedure implementation and continual feedback.
In the preliminary lectures we cover first the nuclear medicine & physics aspects to SNB, followed by the surgery & pathology components. This is complimented with videos of how to undertake SNB, outlining the specific features, positives and pitfalls. In the afternoon there is a practical session where the attendees exhibit the earlier teachings of the day. Each hospital is encouraged to send a team of people forming the nucleus in the provision of the service, who are all sent home with a copy of the lectures and the videos. This proceedure has been analysed by the Royal College of Surgeons and has their approval.
These units (the nucleus mentioned previously) are then encouraged to begin SNB within their hospitals but initially combining it with a neck dissection to prevent error, until 10 cases have been performed successfully. They are then able to continue the procedure without the safety net of a neck dissection. During this period the team is offered mentorship as they proceed through the cases.
The final component has two aspects. In order to ensure that the units are maintaining the highest standard possible, they are asked to complete a form through an electronic database about each patient treated with SNB. We can then monitor their performance and report back to them. HNCF is also contributing to the quality of the procedure and safety of the patients by giving each centre that completes the training a special fluorescent camera for a period of a year. The advantage of this is that we create the tracer molecule injected around the tumour both radioactive and fluorescent. This reduces the chance of error through missing a sentinel node by having two targets on it; one radioactive the second a fluorescent particle. This is a brand new approach to helping maintain quality and optimum success, which we believe to be groundbreaking.
The pictures above and below show the position of the sentinel node after the radiation has been injected around the tumour. It has then spread through the lymph system, highlighting the cancerous area. The left photo is prior to injection and radiation mapping, and the coloured pictures on the right show after the injection.