1) in Your Centre, Is the Sentinel Node Biopsy (SNB) Technique Currently Used As Opposed
1) In your centre, is the Sentinel Node Biopsy (SNB) technique currently used rather than Axillary Lymph Node Dissection (ALND) in clinical practice?
No
Yes
2)If not, what is the main reason?
There are insufficient data in the literatureto justify its use in the daily practice
Nuclear Medicine Department not available
Gamma probe for radio-guided surgery not available
We have not yet completed the learning curve
Other reasons (specify)
3) Is your centre taking part in any multicentric clinical trial on SNB?
No
Yes
4)Do you believe there is currently enough scientific evidence to justify the use of SNB in clinical practice?
Yes
Yes, but precise indications and its limitations are still unclear
No, but due to patient demand, we perform SNB in selected cases.
Absolutely not
5)Do you believe that mass-media propaganda in favour of SNB has in some way lead to its use in the clinical practice?
No
Yes
6)Have you had any experience of patients specifically requesting SNB and refusing, a priori, elective ALND, even after being illustrated the possible risks of the technique?
No
Rarely
Sometimes
Frequently
7)Although the advantages of this technique (less aggressive and with fewer side effects) are well known, what percentage of false negative rate would you consider acceptable?
0%
<5%
5-10%
10-15%
>15%
8)
When did you start to investigate the SNB technique?
Before 1997
1997
1998
1999
2000
2001
2002
2003
9)When did you start to use the SNB instead of ALND in your clinical practice?
Before 1997
1997
1998
1999
2000
2001
2002
2003
10)How many cases of SNB followed by the standard ALND procedure did you perform during your learning phase?
<10
10-20
20-30
>30
11)With time, have you extended the indications of the SNB technique?
No
Slightly
A great deal
12)In which of the following cases do you usually utilise the SNB technique?
Tumours < 1 cm
Tumours < 2 cm
Tumours < 3 cm
Any size
13) Which of the following do you consider a contraindication to SNB?
Multi-centric tumours (multiple foci >2-3 cm apart)
Retroareolar tumours
Non-palpable tumours
Previously biopsied tumours
Previous quadrantectomy (without axillary surgery) in the upper outer quadrant
Previous axillary incision (i.e. for breast implant operation)
Clinically positive axilla
14) Do you perform SNB in cases of ductal carcinoma in situ?
Never
Only if >2 cm
Always
15)Do you perform SNB in patients who have undergone neoadjuvant chemotherapy?
Never
Sometimes
Always
16)What is your usual approach in cases of micrometasasis in the sentinel lymph node?
Always axillary dissection
Axillary dissection with some exceptions
Axillary dissection only in some cases
No further axillary surgery
17)Do you perform frozen section examination of the sentinel lymph node?
usually yes
never
It varies from case to case
18)Do you use local anaesthesia for SNB?
Never
Sometimes
Often
19) Which of the following procedures do you mainly follow in cases of small palpable tumours?
Primary tumour and SN biopsy under local anaesthesia, wait for definitive histology and then perform radical treatment of the breast associated with delayed ALND in cases of positive sentinel node
Perform radical treatment of the primary tumour and SNB, wait for SN definitive histology and then, if necessary, perform a delayed ALND
Perform frozen section examination of the SN and immediate radical breast surgery associated with ALND if sentinel node is positive
20)What SN localisation technique do you use?
Blue dye injection alone
Radio-tracer (99mTc-albumin nanocolloid)
Both the above in association
21)Which site do you usually use for tracer injection in cases of palpable tumour?
Subdermal / intradermal in the tumour area
Deep peritumoural injection
Subareolar
Intratumoural
Fill in this area only if you use radioisotope for sentinel node identification
22)How often do you perform a preoperative lymphoscintigraphy?
Always
Occasionally
Never
23)When is the tracer injected?
The day before surgery
The same day of surgery
It varies from case to case
24)What dose of radioisotope is usually injected?
<30 MBq
30-50 MBq
>50 MBq
25)What type of gamma probe is used?
……………………………………………………………….
26)Which “hot” lymph nodes do you usually remove?
Only the hottest
All nodes with similar radioactivity levels
All nodes with radioactive counts higher than 10% of those measured in the hottest node
All nodes with a radioactivity level greater than that of background activity.
27)Do you also look for radioactive emission along the internal mammary chain during surgery?
Never
Only if highlighted at lymphoscintigraphy
Always
28)If a significant radioactive emission is observed along the internal mammary chain, do you perform internal node(s) biopsy?
Always
Only if no axillary sentinel nodes are found
Never
29)Which site do you usually use for tracer injection in cases of non-palpable tumours?
We never perform SNB in non-palpable tumours
Subdermally in the cutaneous projection of the tumour
Deep in the peritumoural area
In the subareolar area