© 2005 Blackwell Publishing, Inc., 1075-122X/05 The Breast Journal, Volume 11 Number 4, 2005 231–235 Address correspondence and reprint requests to: Robert Martin, MD, University of Louisville School of Medicine, 315 East Broadway, Rm. 313, Louisville, KY, 40202, USA, e-mail: Robert.martin@louisville.edu. Blackwell Publishing, Ltd. ORIGINAL ARTICLE Acceptance of Sentinel Lymph Node Biopsy of the Breast by All General Surgeons in Kentucky C. Adam Conn, MD, Kelly M. McMasters, MD, PhD, FACS, Michael J. Edwards, MD, FACS, and Robert C. G. Martin, MD, FACS Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky  Abstract: Sentinel lymph node biopsy (SLNB) for breast cancer is now performed routinely in many U.S. medical centers. The acceptance of SLNB in the community and in rural medical centers, however, has not been accurately defined. The purpose of this study was to assess how surgeons in Kentucky, a predominantly rural state, have incorporated SLNB into practice. General surgeons in the state of Kentucky were identified by registration with the state medical association. All general surgeons ( n = 272) in the state were mailed the questionnaire, with 93% ( n = 252) responding. Overall, 172 defined themselves as rural surgeons. Among the rural surgeons, 87% perform breast cancer operations and 54% perform SLNB. In comparison, 74% of nonrural sur- geons perform breast cancer operations and 80% perform SLNB. A majority of nonrural surgeons (73%) have performed SLNB for more than 2 years when compared to rural surgeons (73% versus 37%, respectively; p < 0.0001). Planned backup axillary node dissection was stopped by both rural (26%) and community (39%) surgeons after 10 cases (14% rural, 19% nonrural) or 11–20 cases (12% rural, 20% nonrural). Surgeons reported using SLNB for the following diagnoses: invasive cancer (98%), ductal carcinoma in situ (DCIS) (43%), and lobular carcinoma in situ (LCIS) (11%). The majority of surgeons (87%) reported a greater than 90% SLN identification rate. SLNB has become widely accepted by surgeons in both rural and nonrural medical centers in Kentucky. However, there has been considerable variability in the number of training cases surgeons have performed prior to aban- doning routine axillary dissection. This indicates a need for continuing educational efforts aimed at quality assurance.  Key Words: breast cancer, breast neoplasms, lymph node, rural surgery, sentinel node biopsy S entinel lymph node biopsy (SLNB) has become widely accepted as a minimally invasive method of nodal staging for breast cancer. Although there remains some controversy regarding this procedure, the fact remains that it is performed routinely as an alternative to routine level I / II axillary dissection in medical centers around the world (1–11). The acceptance of SLNB in the community and in rural medical centers, however, has not been accu- rately defined. The use of SLNB in nonacademic general surgery practices has become common only within the last 5 years. Most general surgeons in practice have been out of residency since the widespread use of SLNB began. In Kentucky, where the mean age of practicing general surgeons is 46 years, the vast majority of surgeons did not learn this tech- nique during their training. Thus many general surgeons have learned this technique from educational courses, colleagues, and partners; many may in fact be self-taught. The purpose of this study was to assess how surgeons in Kentucky, a predominantly rural state, have incorporated SLNB into their practice. MATERIALS AND METHODS General surgeons in the state of Kentucky were identified by their registration with the Kentucky Board of Medical Licensure. The questionnaire was developed specifically for this study and was field tested on a small number of local surgeons. The one-page questionnaire involved 17 questions related to the surgeon’s breast cancer experience, training for and experience with SLNB, and indications for use of this technique. A nonrural surgeon for this study was defined as a sur- geon working within the two major metropolitan areas in Kentucky (Louisville and Lexington). A rural surgeon was defined as a surgeon working outside of these two areas, which is defined as working in an area in which the popu- lation is less than 75,000 people. Performing SLNB was defined as the act of utilizing blue dye or radiocolloid to identify a SLN with or without backup axillary lymph node dissection. For this study, we used a modified Dillman Address correspondence and reprint requests to: Robert Martin, MD, University of Louisville School of Medicine, 315 East Broadway, Rm. 313, Louisville, KY, 40202, USA, e-mail: Robert.martin@louisville.edu.