Perfil enfermera referente de ganglio centinela: descripción, validación y aplicación en la práctica asistencial / Sentinal lymph node reference nurse model: description, validation, and application in clinical practice

Introducción En 2019 se genera la oportunidad de integrar un enfermero en el equipo de cirugía radioguiada (CRG), adaptando el modelo de enfermera referente a las exploraciones de ganglio centinela (GC). Objetivos Describir el procedimiento adoptado para definir el perfil enfermera referente de ganglio centinela (ERGC), validar su aplicación práctica y establecer su implementación asistencial. Material y métodos Metodología de análisis y mejora continua en gestión de procesos (ciclo PDCA): definición y planificación de las funciones de ERGC en el protocolo de cáncer de mama, realización prueba piloto con 20 pacientes y análisis de los datos de cara a validar el circuito y establecer su implementación asistencial. Resultados Se elaboraron flujos del procedimiento, integrando la figura de ERGC. En la prueba piloto, un 15% de las mujeres presentaron un resultado positivo de ansiedad frente a un 60% de valoración subjetiva positiva de ansiedad. Tras las intervenciones enfermeras realizadas, se obtuvo una reducción del 58,3% en valoración subjetiva de ansiedad, un 100% de conocimiento de la prueba y una valoración del dolor en la administración del radiotrazador aceptable en las pacientes. En el nivel de calidad técnica, 8/10 ítems valorados consiguieron el objetivo previamente establecido por el equipo de CRG. Conclusiones La creciente complejidad de la técnica de biopsia de GC ha creado la oportunidad de implementar cuidados enfermeros en el procedimiento de localización prequirúrgica del GC. El perfil ERGC es el idóneo para llevarlo a cabo y ha conllevado mejoras objetivas en los diagnósticos enfermeros e ítems evaluados (AU)

Introduction In 2019 the opportunity to add a nurse within the radioguided surgery (RGS) team was generated. The referent nurse model was adapted to, the sentinel node (SN) preoperative approaches. Objectives To describe the process performed to define the sentinel node referentnurse (SNRN) profile, to validate its practical application and to establish its clinical implementation. Material and methods Methodology of analysis and continuous improvement in the management of processes (cycle PDCA): Definition and planning of the SNRN functions in the breast cancer protocol, performance of a pilot test with 20 patients and analysis of the data in order to validate the circuit and establish its final clinical implementation. Results New procedure flows-charts were elaborated, adding the figure of the SNRN, its function and nursing interventions during the process. In the pilot test a 58.3% reduction in subjective anxiety, a 75% decrease of the overall anxiety level, a 100% knowledge of the test and an acceptable patient perception of pain's level during the radiotracer administration were obtained. Regarding technical quality, 8/10 items assessed reached the level previously established by the RGS team. Conclusions The increasing complexity of the SN biopsy technique has created the opportunity to implement nursing care in the presurgical SN localization process. The profile of the SNRN is ideal for carrying it out and has led to improvements in the nursing diagnoses and assessed items (AU)

Manejo de la axila en el cáncer de mama: menos es más, más es menos o todo lo contrario / Management of the axilla in breast cancer: less is more, more is less or the other way around

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SEOM clinical guidelines in early-stage breast cancer 2015

Breast cancer is a major public health problem. Despite remarkable advances in early diagnosis and treatment, one in three women may have metastases since diagnosis. Better understanding of prognostic and predictive factors allows us to select the most appropriate adjuvant therapy in each patient. In these guidelines, we summarize current evidence for the medical management of early-stage breast cáncer (AU)

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SEOM guidelines for the management of Malignant Melanoma 2015

All melanoma patients must be confirmed histologically and resected according to Breslow. Sentinel node biopsy must be done when tumor is over 1 mm or if less with high-risk factors. Adjuvant therapy with interferon must be offered for patients with high-risk melanoma and in selected cases radiotherapy can be added. Metastatic melanoma treatment is guided by mutational BRAF status. BRAF wild type patients must receive anti-PD1 therapy and BRAF mutated patients BRAF/MEK inhibitors or anti-PD1 therapy. Up to 10 years follow up is recommended for melanoma patients with dermatologic examinations and physical exams (AU)

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Local treatment of breast cancer.

OBJECTIVES: To describe the local control of breast cancer, including initial biopsy, lumpectomy or mastectomy, and sentinel node biopsy or axillary node dissection, and to discuss the role of radiation therapy following lumpectomy or mastectomy in advanced cancer. DATA SOURCES: PubMed, Scopus, Cochran. CONCLUSION: The local treatment of breast cancer is an essential component of primary breast cancer treatment. Residual cancer cells may increase the risk of recurrent ipsilateral disease. IMPLICATIONS FOR NURSING PRACTICE: Nurses and advanced practice nurses who provide care for cancer survivors should possess the skills to patiently teach information, empathetically understand the flagrant or suppressed emotional turmoil, explain the full complement of treatment options, appreciate the rationale behind choices made, and help patients navigate the educational and decisional byways.

Relieving the pain of sentinel lymph node biopsy tracer injection.

Sentinel lymph node biopsy (SLNB) has been reliably accurate as a minimally invasive surgical alternative for identifying lymphatic breast metastasis. During mapping, the injection of a radioactive tracer or isosulfan blue dye to differentiate the SLN is acutely painful. The use of the eutectic mixture of lidocaine and prilocaine (EMLA) cream to reduce tracer injection pain has been reported anecdotally. A retrospective study compared injection discomfort of 20 women who had undergone SLNB without EMLA and 20 women who had undergone SLNB with the EMLA protocol. Results indicated a significant difference in mean pain rating. Standards of care should include the use of EMLA prior to intradermal SLN tracer injection unless contraindicated.

The role of sentinel node biopsy in patients with cutaneous melanoma.

The role of sentinel lymph node biopsy (SLNB) as a prognostic indicator in melanoma patients has been controversial in the fields of surgical oncology and dermatology for decades. This minimally invasive surgical technique was introduced in 1990 for diagnosing melanoma lymphatic metastases and has been deemed the standard of surgical care of cutaneous malignant melanoma by the World Health Organization and the Sunbelt Melanoma Clinical Trial. Its usefulness as a prognostic indicator of metastases led to expanded applications for breast, colon, gastric, esophageal, head and neck, thyroid, and lung cancers. This article first provides an overview of cutaneous melanoma and staging methods and treatment modalities. A brief study of the lymphatic system and the SLNB procedure are reviewed, followed by a discussion of its usefulness in patients who have melanoma, including risks and benefits. This article also discusses nursing considerations for patients undergoing the procedure, and patient education tips. Lastly, future indications for SLNB and new prognostic indicators for melanoma are discussed.

Eighteen sensations after breast cancer surgery: a comparison of sentinel lymph node biopsy and axillary lymph node dissection.

PURPOSE/OBJECTIVES: To evaluate prevalence, severity, and level of distress of 18 sensations at 3-15 days (baseline), 3 months, and 6 months after breast cancer surgery; to compare sentinel lymph node biopsy (SLNB) to SLNB with immediate or delayed axillary lymph node dissection; to evaluate the Breast Sensation Assessment Scale(c) (BSAS(c)) for reliability and validity. DESIGN: Prospective, descriptive. SETTING: Evelyn H. Lauder Ambulatory Breast Center at Memorial Sloan-Kettering Cancer Center in New York City. SAMPLE: 283 women with breast cancer; 187 had SLNB, and 96 had SLNB and axillary lymph node dissection. METHODS: Patients completed the BSAS(c) at baseline, three months, and six months after surgery. MAIN RESEARCH VARIABLES: Prevalence, severity, and level of distress of sensations in patients who had breast cancer surgery. FINDINGS: Sensations were less prevalent, severe, and distressing following SLNB compared with axillary lymph node dissection at all three time points. Tenderness and soreness remained highly prevalent following SLNB at the three time points. Tenderness, soreness, tightness, and numbness were among the most severe and distressing symptoms in both groups. The BSAS(c) demonstrated good reliability and validity. CONCLUSIONS: Overall prevalence, severity, and level of distress were lower following SLNB compared with axillary lymph node dissection at baseline, three months, and six months after surgery. Certain sensations remained prevalent, severe, and distressing in both groups. The BSAS(c) is a reliable and valid instrument. IMPLICATIONS FOR NURSING: Nurses should be familiar with prevalent sensations patients experience after SLNB and axillary lymph node dissection so they can provide education and support.

Sentinel lymph node biopsy for breast cancer.

In a health care system in which decreasing costs, increasing quality, and minimizing morbidity are emphasized, new, less invasive surgical techniques are gaining popularity. Sentinel lymph node biopsy is one such procedure used to treat many types of breast cancer. By performing a biopsy of this node, which receives lymphatic drainage from the tumor, the surgeon can predict the status of all nodes in the axillary region and accurately diagnose stages of cancer, thus eliminating axillary dissection for 55% to 70% of patients. Successful outcomes result from a concerted effort among the nuclear medicine physician, radiologist, surgeon, and surgical team members.

Sentinel lymph node biopsy in breast cancer: scientific rationale and patient care.

PURPOSE/OBJECTIVES: To describe the history of sentinel lymph node biopsy (SLNB), review the current scientific literature comparing the benefits and shortcomings of SLNB with traditional axillary lymph node dissection, and describe the nursing role that should be employed when instructing patients who are considering SLNB. DATA SOURCES: Journal articles, published research data, and clinical experience. DATA SYNTHESIS: Traditional axillary lymph node dissection has the potential to cause serious complications such as lymphedema, scarring, numbness, pain, and psychological distress. Given that approximately 70% of women with early-stage breast cancer will have no evidence of regional lymph node involvement at the time of surgery, determining who is likely to have negative nodes will spare women these potential complications. SLNB can significantly minimize the morbidity associated with axillary lymph node dissection while providing accurate diagnostic and prognostic information. CONCLUSION: SLNB has been well documented in the scientific literature from multiple phase III clinical trials as an accurate, safe, and fiscally conservative alternative to traditional axillary lymph node dissection for women who present with early-stage breast cancer. Furthermore, future results from multicenter, randomized clinical trials now under way ultimately will determine the role for SLNB in the years to come. IMPLICATIONS FOR NURSING PRACTICE: Nurses in the outpatient setting can help to minimize the anxiety and fear that patients have when they are considering SLNB versus the more traditional axillary lymph node dissection. Oncology nurses also serve as resources to other nurses, healthcare professionals, and the public as more information is learned concerning the role of SLNB in early-stage breast cancer.

Sentinel lymph node dissection as a means of managing breast cancer.

Sentinel lymph node dissection is a minimally invasive procedure designed to identify and remove specific lymph nodes suspected of containing metastatic cancer cells. First, a surgeon maps sentinel lymph nodes by tagging them with a radioisotope. He or she then uses a hand-held gamma probe intraoperatively to identify lymph nodes likely to contain metastases of primary lesions (e.g., cancers of the breast, prostate, and parathyroid; melanomas). Sentinel lymph node dissection is precise and considerably less traumatic for the patient than the traditional surgical treatment of complete lymph node dissection. This article discusses the use of sentinel lymph node dissection as a diagnostic tool and treatment for breast cancer.

Lymphatic mapping and sentinel lymph node biopsy.

Malignant melanoma--cancer of the pigment cells--has the highest mortality rate of all skin cancers. With early detection and treatment, however, malignant melanoma is highly curable. Recently, diagnostic modalities for nodal involvement have been perfected, reducing the morbidity of elective lymph node dissections and rendering them unnecessary in many cases. Total lymphadenectomy procedures are being replaced by intraoperative lymphatic mapping and sentinel lymph node biopsy using gamma detector probes. This article reviews lymphatic drainage from the primary site to possible lymph node basins and selective lymph node dissection using lymphoscintigraphy and intraoperative mapping as guides. This article also includes a case study, beginning with a diagnosis of malignant melanoma and following a successful postoperative course.