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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2016

01-10-2016 | Breast Oncology

A Picture is Worth a Thousand Words: Intraoperative Photography as a Quality Metric for Axillary Dissection

Authors: Brittany L. Murphy, MD, Judy C. Boughey, MD, Amy C. Degnim, MD, Tina J. Hieken, MD, William S. Harmsen, MS, Gary L. Keeney, MD, James W. Jakub, MD

Published in: Annals of Surgical Oncology | Issue 11/2016

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Abstract

Background

The adequacy of an axillary lymph node dissection (ALND) is frequently assessed by the number of LNs pathologically identified. We hypothesized that intraoperative photographs facilitate objective measurement of the surgical quality of an ALND.

Methods

Intraoperative photographs of the axilla were obtained prospectively following ALND by four surgeons. An objective scoring system was created based on the visibility of anatomic landmarks, with a maximum score of 7. Photographs of each case were scored independently by the other three surgeons. Factors thought to influence LN count were evaluated for correlation. Interrater variability was calculated.

Results

A total of 115 cases were evaluated: 98 breast and 17 melanoma. Mean LN count was 25.1 (SD 10.5): 23.2 (SD 7.9) for breast and 36.5 (SD 15.8) for melanoma. Ninety percent of cases had a LN count ≥15. Factors associated with a higher number of LNs were melanoma (p < 0.001), visualization of the axillary vein (p = 0.03), and long thoracic nerve (p = 0.04). There was no association with age, body mass index, number of positive LNs, neoadjuvant chemotherapy, or matted LNs. Mean ALND photograph score was 4.8 (SD 1.3). A 1-point change in total score increased the mean LN count by 2.4 (p = 0.002). Correlations for interrater reliability varied from 0.27 to 0.62.

Conclusions

Photographic visualization of axillary anatomic structures correlates with the number of LNs identified on pathology. These findings support initiating a larger study with more surgeons to define the optimal photo metrics of an adequate ALND.
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Metadata
Title
A Picture is Worth a Thousand Words: Intraoperative Photography as a Quality Metric for Axillary Dissection
Authors
Brittany L. Murphy, MD
Judy C. Boughey, MD
Amy C. Degnim, MD
Tina J. Hieken, MD
William S. Harmsen, MS
Gary L. Keeney, MD
James W. Jakub, MD
Publication date
01-10-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 11/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5271-7

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