Training for medical professionals – about SNB
For the management of patients with early-stage cancers
SNB has been endorsed by the National Institute for Health and Care Excellence (NICE), is fully adopted in Denmark and the Netherlands, and is growing in deployment across Europe and the US.As knowledge among the public grows about head and neck cancers and patients' rights to opt for Sentinel Node Biopsy treatment, UK surgeons should act now to learn, test and adopt the technique in order to meet that demand.
What we do
At the Head and Neck Cancer Foundation, we provide a starter kit and a training programme for medical teams who are keen to offer this pioneering surgical technique to their patients. We provide group and individual training to all members of the treatment and theatre teams.
As we introduce SNB across the UK, we are attempting to do so in such a way as to keep the error rate low across all hospitals adopting the procedure. We will achieve this by working with hospital teams through our extensive programme and post-training support.
National training programme - NICE approved and endorsed
Our training is approved by the Royal College of Surgeons and completion of it awards 5 CPD points.
It also complements the National Institute for Health Care and Excellence (NICE) recommendations that SNB is an alternative to elective neck dissection (END) and should be considered for patients with early (stage 1 and 2) mouth cancer.
SNB is an operator-sensitive procedure with the best units reporting false negative rates down to 5-8%. The false negative rate for new adopters ranges from 13%-40%. Only half of these patients can be rescued when the clinically obvious disease appears in the neck.
What does HNCF's training aim to achieve?
The intention of this programme is to introduce head and neck SNB in a uniform way across the country with a well-structured and high-quality course. The objective is to have a uniform standard of SNB practice in the UK proven by a low incidence of false negative results and validated through an online database.
With your collaboration, we think we can deliver on these objectives. The accuracy of the SNB test depends on a team of people working together. Consequently, the training programme is designed for hospital teams attending collectively.
There are three core components to our training
Our training encompasses initial lectures, procedure implementation and continual feedback. Below we explain in greater detail how these work in practice for healthcare professionals.
Component One: Initial Lectures
In the preliminary lectures, we cover first the nuclear medicine and physics aspects to SNB, followed by the surgery and pathology components. This is complemented with videos of how to undertake SNB, outlining the specific features, positives and potential pitfalls. There is also a practical session where attendees demonstrate the earlier teachings of the day. Each hospital or trust is encouraged to send a team of people who will form a nucleus in the provision of the service. Each attendee will receive a comprehensive pack containing all learning materials, lecture notes and access details for training videos and the database. This procedure and process has been analysed by the Royal College of Surgeons and has received its official stamp of approval.
Component Two: SNB Implementation
These trained teams are encouraged to begin SNB within their hospitals - but initially to combine it with a neck dissection to prevent error. Once 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 mentoring as they proceed through each case.
Component Three: Continual Feedback
The final component has two aspects. In order to ensure that the teams 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 one year. This is an advantage because we make the tracer molecules injected around a tumour both radioactive and fluorescent. This reduces the chance of error through missing a sentinel node by having two targets on it; one radioactive and the second fluorescent. This is a brand new approach to helping maintain quality and optimum success, which we believe to be groundbreaking in the treatment of head and neck cancers.
Putting training into practice
We complement this training programme by offering each unit that has completed the training pathway access to state of the art technology which helps surgeons see the sentinel nodes at the time of surgery by making them fluoresce. We supply a fluorescent camera for a period of one year to help surgeons get accurate results as they introduce the technique to their practice. Once you and your patients have seen the benefits, which include more than just use in sentinel node biopsy, then you have the chance to purchase the resources you need.
The sentinel node
This graphic shows the position of the sentinel node after the radiation has been injected around a tumour. The radiation has then spread through the lymph system, highlighting the cancerous areas. The left-hand side is prior to the injection and radiation mapping process. The coloured areas on the right-hand side show the identification of cancerous cells.
Maarja Kikas, UCLH NHS Foundation Trust
"As a Head and Neck CNS, it is essential for me that we give our patients the best possible survival chances with minimal interventions. Early detection of migrating cancers cells to the neck is paramount for the best patient outcomes. SNB training day is an excellent opportunity to understand the procedure in-depth and learn the evidence behind it. I am happy to use this knowledge and apply this to my daily practice when educating my patients and discussing treatment options with them. Brilliant day, definitely recommend to all senior nurses."
How do I register my team for training?
Registration as a hospital team is required. A team consists of two surgeons, one nuclear medic, a theatre nurse and one pathologist. If your centre has no pathologist, then cover can be provided.
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SNB Training resources
To see a copy of our training schedule please click below.