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Résumé Les cancers de l’endomètre sont découverts majoritairement à un stade précoce justifiant une retenue thérapeutique. La conduite à tenir thérapeutique est aujourd’hui fondée sur des classifications préopératoires basées sur les éléments histo-pronostiques de la tumeur, et son extension mesurée en imagerie médicale : en particulier le curage ganglionnaire dans les formes à risque bas et intermédiaire n’est plus systématiquement réalisé. Or, un certain nombre de patientes présente in fine une atteinte ganglionnaire justifiant probablement des thérapeutiques adaptées chirurgicales ou adjuvantes. La technique du ganglion sentinelle permettrait de compenser les faiblesses de l’évaluation pronostique préopératoire sous réserve d’un consensus sur sa réalisation technique, la définition de ses critères de qualité et la gestion de ses résultats en particulier en cas de métastases ganglionnaires de faible volume. The endometrial cancers are mainly discovered at an early stage justifying a less aggressive treatment. The therapeutic choices are today based on preoperative classifications themselves based on histo-prognostic factors of the tumor and its extension measured in MRI: consequently, lymph node dissection in case of low and intermediate risk cancer is not systematically achieved. But a number of patients have lymph node involvement finally, probably justifying an adapted surgical and adjuvant treatment. The technique of sentinel node would compensate the weaknesses of preoperative prognostic evaluation. This new operative technique needs to be precised and evaluated: the topics subject to discussion are the technical implementation, the definition of its quality standards and the management of its histological results especially in cases of low volume lymph node metastasis. [ABSTRACT FROM AUTHOR]

Résumé La procédure ganglion sentinelle (GS) est la technique recommandée pour l’exploration chirurgicale axillaire dans le cancer du sein localisé sans atteinte clinique ou radiologique ganglionnaire axillaire. Cette technique chirurgicale est fondée sur une double détection isotopique et colorimétrique. Bien qu’elle permette une réduction significative de la morbidité axillaire par rapport au curage axillaire (CA), cette procédure induit un certain nombre de contraintes organisationnelles, notamment pour l’injection radio-isotopique. C’est en particulier pour ces raisons que d’autres méthodes d’identification des GS sont apparues depuis quelques années dont certaines semblent prometteuses (détection par la fluorescence et fer magnétique). L’objectif de cet article a été d’effectuer une synthèse sur la méthode de détection de référence (radio-isotopique) des GS et d’analyser la littérature récente portant sur les nouvelles méthodes de détection. The sentinel node procedure (GS) is the recommended technique for axillary surgical exploration in localized breast cancer with no clinical or radiological lymph node involvement. This surgical technique is based on a dual isotope and colorimetric detection. Although it allows a significant reduction in morbidity compared to axillary dissection (CA), this procedure induces a number of organizational constraints, in particular for the radioisotope injection. Specially for this reason, other GS methods have emerged in recent years, some of which appear promising (detection by fluorescence and magnetic iron). The objective of this paper was to carry out a synthesis of the reference method of detection (radioisotope) GS and analyze the recent literature on new detection methods. [ABSTRACT FROM AUTHOR]

Résumé Chez les patientes atteintes de cancer du sein, la détection de micrométastases au niveau ganglionnaire axillaire a été plus fréquente et mieux définie avec l’introduction de la technique du ganglion sentinelle. Dans cet article, nous nous limiterons aux cas de micrométastases de stade pN1mi en analysant les données de littérature afin de préciser les éléments de décision d’indication du traitement locorégional. In patients with breast cancer, axillary lymph node micrometastasis detection has been more frequent with a better definition since the introduction of the sentinel node procedure. In this review, we focus on pN1mi micrometastasis and review the literature in order to determine factors involved in making the decision of a regional treatment. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: Évaluer l’exposition aux rayonnements ionisants du personnel du bloc opératoire gynécologique lors de la recherche du ganglion sentinelle à l’aide d’un traceur radioactif, les micro-colloïdes d’albumine marqués au technétium-99m. Matériels et méthodes: Étude monocentrique, prospective, menée sur un trimestre, au cours de 40 chirurgies de recherche de ganglion sentinelle. Les mesures dosimétriques sur le personnel (chirurgien, aide-opératoire et infirmière de bloc) ont été réalisées avec des dosimètres passifs et des bagues dosimétriques, complétées par des mesures dosimétriques d’ambiance dans la salle de chirurgie. L’activité moyenne calibrée de 99mTc-colloïdes d’albumine était de 50,1±2,4 MBq le jour de la chirurgie ou de 90,4±3,2 MBq pour une injection la veille. Résultats: Les doses radioactives moyennes reçues pour chaque intervention par le chirurgien, l’aide-opératoire et l’infirmière de bloc sont respectivement de 5, 3,75 et 0μSv pour l’exposition au corps entier, et de 17,5, 15,6 et 16,2μSv aux extrémités. Les doses d’ambiance sont indétectables. Sachant que 7 chirurgiens se répartissent équitablement les 200 interventions/an, l’irradiation au corps entier et aux extrémités de chaque chirurgien est inférieure aux seuils annuels de 1 et 50mSv fixés par la Commission internationale de protection radiologique pour le public. Discussion et conclusions: Lors d’une chirurgie de recherche du ganglion sentinelle utilisant un traceur radioactif, le personnel du bloc n’est que très faiblement irradié, ce qui permet de considérer son exposition semblable à celle du public. La surveillance dosimétrique et l’utilisation d’équipements de protection contre les rayonnements ionisants n’est donc pas nécessaire. [ABSTRACT FROM AUTHOR]

Axillary lymph node dissection (ALND) for micro- or macrometastases in sentinel node is questioned by recent trial results. We reported some results of the following questions: 1) What is the non-sentinel node rate in case of involved sentinel node? 2)What is the impact of ALND omission on axillary recurrence, 3) on survival rate and 4) on adjuvant treatment indication? Inclusion in prospective randomised trial is recommended because the sufficient level of evidence is not demonstrated to propose ALND omission in routine practice. [ABSTRACT FROM AUTHOR]

The sentinel lymph node (SN) status is a crucial parameter in the therapeutic approach to breast cancer. However, there is no consensus established yet with regards to the method of SN assessment. The SN assessment ex tempore determines its status during a surgical procedure, thus allowing complete axillary dissection in case of SN positivity. That analysis is not performed systematically and can be done by cytological, histological (frozen sections) or molecular methods (qRT-PCR). The methods differ in sensitivity; qRT-PCR seems to be the most sensitive. The definitive SN status is also assessable by various approaches, immunohistochemistry (IHC) being the preferred one. However, the primacy of IHC is challenged by molecular biology methods. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Vulvar cancer is usually treated with vulvectomy and bilateral groin lymphadenectomy, which result in serious morbidities while only 30% of patients have positive nodes. The sentinel node technique has good sensitivity and specificity for detecting lymph node involvement while minimizing postoperative morbidity. The aim of this study was to evaluate the specific and overall survival impact of sentinel lymph node procedure versus inguinofemoral lymphadenectomy in patients with vulvar cancer. Patients and methods: This is a retrospective study from the Surveillance, Epidemiology, and End Results (SEER) database on patients with vulvar squamous cell carcinoma, T1 or T2 stage, metastatis-free, followed between 2004 and 2008. Results: One thousand and thirty eight patients had a systematic groin lymphadenectomy and 56 a sentinel node technique (including 22 with an associated lymphadenectomy because of a positive sentinel node). There is no significant difference in overall or specific survival between the two groups. In multivariate analysis, age, T stage and nodal status are prognostic factors for overall and specific mortality (P <0.05). Discussion and conclusion: Sentinel node technique is not associated with an excess risk of mortality or recurrence. [Copyright &y& Elsevier]

L’envahissement ganglionnaire constitue l’un des principaux facteurs pronostiques indépendants dans le cancer du col de l’utérus aux stades précoces et justifie une thérapie adjuvante. Le traitement chirurgical standard du cancer du col précoce (≤ IB1) consiste encore en une colpohysté-rectomie élargie aux paramètres avec lymphadénectomie pelvienne iliaque externe bilatérale et lomboaortique en cas d’atteinte ganglionnaire pelvienne. Dans la littérature, la procédure du ganglion sentinelle (GS), qui permet d’évaluer le statut ganglionnaire, a grâce à la méthode combinée colorimétrique et radio-isotopique un taux de détection supérieur à 90 % et un taux de faux-négatif compris entre 0 et 8 %. L’ultrastadification sur des coupes sériées par immunohistochimie (IHC), voire la réalisation d’une PCR permettent la détection de micromé-tastases et de « nanométastases » non identifiables par les techniques conventionnelles. Dans cet article, nous soulignons les aspects techniques et les résultats de la littérature permettant d’envisager des modifications dans la stratégie de prise en charge du cancer du col de l’utérus aux stades précoces (IA2 et IB1). [ABSTRACT FROM AUTHOR]

Abstract: Lymph-nodal involvement is a major prognostic factor of cervical cancer. Lymph-node status is classically evaluated by lymph-node dissection. This surgical approach has mainly a prognostic interest. The morbidity related to the lymph-node dissection is not nil, so numerous imaging or surgical techniques have been recently developed in order to reduce this morbidity. Currently, even with the progress of the imaging techniques, surgical lymph-node dissection is the standard approach. For the management of early cervical cancer, surgery is usually the sole treatment. In association with a laparoscopic lymph-node dissection, the sentinel node technique is a new approach that gives interesting data: possibility of performing frozen sections on the sentinel nodes in order to improve the management, discovery in an important proportion of cases of abnormal lymphatic pathways that are a potential aetiology of recurrence, and identification of lymph-node micrometastases that seem to be an important independent prognostic factor. In the future, evaluation of only the sentinel nodes may replace the pelvic lymph-node dissection. For advanced cervical cancers, the treatment is based on chemoradiotherapy. The paraaortic lymph-node status is an important prognostic factor that helps for defining the radiotherapy fields. New imaging techniques as PET Scan, may help for the evaluation of paraaortic lymph-node status. If the PET Scan is positive at the paraaortic level, there is no need for paraaortic lymph-node dissection and radiotherapy should be performed with pelvic and abdominal fields. But the false negative rate of the PET Scan is high and laparoscopic paraaortic lymph-node dissection is required in case of negative PET Scan at the paraaortic level. [Copyright &y& Elsevier]

Abstract: Early stage of cervical cancer is defined by disease confined to the cervix and upper vagina (stage IA to IIA). For early stage, no treatment has demonstrated clear superiority. Treatment options for women with early stage include either exclusive radiotherapy, or radical surgery, or brachytherapy before radical surgery. Radical hysterectomy or trachelectomy include the resection of the parametrium. The rational of parametrectomy is to remove occult disease in the parametrium and its removal is the cause of much of the morbidity of the surgery, specially urinary complications. This surgery can be performed by laparascopy with quality of life improvement and less blood loss but urinary morbidity is still important. The question is if it''s possible to be less radical and still oncologically safe. Parametrial invasion is rare in patients with small tumours without lymphovascular space involvement and negative pelvic nodes (no poor prognostic factors). Sentinel node negative could be a strong criteria to predict parametrial involvement. This review reports studies exploring the safety of omitting parametrectomy in these low risk patients and the future possibilities to evaluate these new indications. [Copyright &y& Elsevier]

Node involvement is a major prognostic factor in head and neck cancers. Among N0 staged patients, because 15 to 30% have occult node metastasis, systematic radical modified neck dissection is frequently performed, although it is subsequently demonstrated to have been unnecessary in two thirds of the cases. With respect to minimal invasive surgery, an understanding of the head and neck lymphatic anatomy and experience of sentinel node biopsy in cutaneous melanoma and breast cancer endorse such an approach, particularly for T1–T2 N0 head and neck squamous cell carcinoma of the oral cavity and oropharynx. Progress in histological diagnosis is expected by way of targeted cervical lymphatic molecular analysis. [ABSTRACT FROM AUTHOR]

Radioguided occult lesion localisation (ROLL) is a new technique which allows identification of non palpable breast lesion in breast cancer using, on the model of sentinel node procedure, injection of a radiotracer over the tumour lesion. With a gamma detection probe, it is then possible during surgery to identify in the same time the lesion and the sentinel lymph nodes. Compared with the wire-guided localisation (WGL), ROLL seems easier to achieve for radiologists, the excision procedure seems to be simpler with a good lesions resection in sano rate and a good cosmetic result. [Copyright &y& Elsevier]

The sentinel lymph node procedure has become the standard in the surgical management of localised breast cancer. However, it is submitted to the uncertainties of intraoperative examination. Indeed, intraoperative examination has three major disadvantages: the type of histological method (frozen section versus imprint cytology), the size of sentinel node metastasis (macro- versus micrometastases) and the time requested for this technique. All of these limits are responsible for secondary re-interventions to complete axillary lymph node dissection. Few medical teams have described a new surgical strategy to avoid these limits. They proposed the detection of the sentinel lymph node under local anaesthesia and to wait for the definitive histological analysis before carrying out lumpectomy and axillary lymphadenectomy if necessary under general anaesthesia. We realized a review of the literature on this new procedure to evaluate its feasibility and to assess the technical aspects. [Copyright &y& Elsevier]

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Sentinel lymph node (SN) biopsy for breast cancer has been introduced in the mid-1990s and it has now been performed on thousands of patients. This procedure has been rapidly adopted around the world by surgical specialists in clinical practice as a diagnostic procedure instead of the axillary lymph node dissection. The diffusion of the SN mapping in routine must be careful by respecting some principles of methodology and especially of training, in order to maintain its irreversible development. However, the advent of this mini-invasive technique revealed new questions, which the concept of the SN procedure raises: can we increase the current indications? Could axillary lymph node dissection be avoided in patients with metastatic SN? What is the morbidity of the biopsy of the SN? Which is the prognostic value of micrometastatis discovered by the diffusion of the ultra-stadification of the SNs? The GS procedure is a diagnostic method the reliability of which is now on accepted in its usual indications (tumours in place, small size breast tumour without palpable adenopathy). The value of the axillary dissection after metastatic SN is the subject of debates and controversies although axillary dissection remains recommended. So the use of scores or predictive nomograms is currently developed to select the patients being able not to justify of complementary axillary dissection, and seems promising. [Copyright &y& Elsevier]

Abstract: In cervical cancer, lymph node status is a major prognostic factor and a decision criterion for adjuvant therapy warranting the lymphadenectomy. The sentinel node procedure, which has emerged to reduce morbidity of extensive lymphadenectomy, remains a major step in the surgical management of solid cancers. Sentinel node procedure has become a standard technique for the determination of the nodal stage of the disease in patients with melanoma, vulvar cancer and recently in breast cancer. In cervical cancer, the sentinel node biopsy is still at the stage of feasibility. In this article, we review the technical aspects, results and clinical implications of sentinel node procedure in cervical cancer. [Copyright &y& Elsevier]

Abstract: Introduction: Since 1992, sentinel node (SLN) biopsy was generally applied to melanoma for carcinologic staging. Literature points out an increase of nodes removed for each procedure. It means to a high cost for this procedure and it wanders from the defining concept of SLN. The aim of our study was to evaluate whether, we can minimize number of SLN removed, without influencing the reliability of carcinologic staging. Material and methods: We conducted a prospective study about 50 patients with stage one melanoma. For each patient, the SLN was identified with hand-held gamma probe technique. We removed only the hottest and all nodes greater than 70% of the hottest. We analysed the characteristics of melanoma, the success rate of this procedure, how many nodes have been removed and how many have had micro-metastases. This result was compared to two main studies with χ2 test. Results: The success rate of this technique was 100%. We dissected 1,3 SLN for each patient, with 22% positive SLN. Statistical analyse pointed out a better selectivity of our study, rate of pathological positivity and recurrence was alike. Discussion: Our technique decreasing number of removed SLN is reliable. A minimal number of nodes doesn''t distort sensitivity of carcinologic staging, and reduce cost of the procedure. [Copyright &y& Elsevier]

Abstract: Vulvar cancer represents approximately 4% of all gynecologic malignancies and the most important prognosis factor in this cancer is the status of the regional lymph nodes. The radical inguinal lymphadenectomy, associated or not with radiotherapy, is accompanied by high morbidity, which can affect 50% of the patients. The sentinel node detection appears now to be feasible in patients with vulvar carcinoma, in order to reduce the morbidity of inguinal lymphadenectomy. But contrary to breast cancer, the learning curve is not easy to obtain because of the low number of cases. That is why we have described the procedure of selective lymphadenectomy. The aim of this technique is to remove the blue and/or marked inguinal lymph node and any other palpable lymph node, without a real radical inguinal lymphadenectomy. Thus, since November 2003, 4 procedures have been performed in total. With the lymphoscintigraphy, we identified 17 marked lymph node and we finally obtained 28 lymph nodes after surgery, with only one metastatic lymph node. There was no complication after our procedure. Selective lymphadenectomy appears to be a new procedure which may reduce the morbidity of usual inguinal lymphadenectomy. [Copyright &y& Elsevier]

Abstract: Purpose: To evaluate the accuracy of sentinel node biopsy for assessing the neck status for those patients with squamous cell carcinoma T1T2N0 of oral cavity. Patients and Methods: 55 patients were included in a prospective study between 2000 and 2003. 53 underwent a sentinel node biopsy (SNB) followed by an elective neck dissection (END). Pathological examination with stepped serial sectioning and immunohistochemistry of sentinel node (SN) has been compared with routine pathology examination of remaining END nodes. Results: 12 patients had a positive SN. No false negative was found. Patient follow up on, at less of 3 years, did not show any node recurrence for those patients with negative SN. After that study, 44 patients had a SNB without END. 7 patients had a positive SN. Follow up showed a node recurrence for 3 patients. In two of these, pathological reexamination showed a micrometastase in SN. SN failure rate is less than 3% for those 99 patients. Conclusion: SNB is a liable procedure. Failure rate is the same as in END. We plan to use this procedure in orophyngeal tumors where it could be possible to reduce irradiation fields and treatment sequels for those patients with negative SN. [Copyright &y& Elsevier]

Abstract: Objective: Sentinel node (SN) identification in vulvar carcinoma would avoid groin dissection and its complications in early stages, but we first have to validate the method, as an unrecognised node metastasis is detrimental to survival. Patients and methods: Since June 2002, 38 patients with T1 or T2 lesions underwent SN identification by radioactive tracer injection and scintigraphy with, on the following day, per operative use of a handheld probe±patent blue dye. In case of a midline lesion, a bilateral inguinal dissection was performed whatever the result of SN identification. SN free from disease were ultrastaged with immunohistochemistry. Results: 1 or more SN were identified in 36 out of 38 patients. 64 groins were analysed, 15 with node metastases. In 9 out of these 15 cases the SN was metastatic, in 5 it had not been identified, and in 1 it was a false negative. In these last 6 cases, there were massively metastatic nodes in the groin. In 19 out of the 26 midline lesions the surgeon identified only unilateral SN. The side without SN contained metastatic nodes in 5 cases. Discussion and conclusion: Failure in SN identification is sometimes related to a massively invaded node. This should be taken into account especially in the management of midline tumors where a seemingly unilateral drainage at scintigraphy warrants nevertheless a surgical assessment of the mute groin. [Copyright &y& Elsevier]

For 10 years numerous studies have shown that the status of the sentinel lymph node is an accurrate predictor of the status of the axillary nodes. This technique still requires validation because numerous questions remain unresolved. Sentinel lymph node biospy must not be performed as a routine technique. The teams involved in sentinel biopsy research need to participate in the International or National Trials. [ABSTRACT FROM AUTHOR]

Objective – To evaluate and accredit the sentinel lymph node biopsy in the surgical treatment of breast cancer in our institute.Patients and methods – From February to September 2001 at Tenon Hospital, 64 patients with breast cancer and clinically negative node underwent sentinel lymph node biopsy followed immediately by standard axillary dissection. Both blue dye and radioisotope were used in the majority of patients (70,4 %) to identify the sentinel node. These sentinel nodes were evaluated by hematoxylin and eosin, immunohistochemistry and multiple sections.Results – The mean tumor diameter was 17.2 mm (range, 7 to 40 mm). The sentinel node was identified in 97 % of the cases (62/64). Of the 62 patients, 24 were histologically positive (38,7 %). The sentinel node was falsely negative in one patient (4 %). In patients with tumors less than 20 mm, the identification and false negative rates were 97.8 % and 0 %, respectively.Conclusions – Our study confirms the validity of the sentinel lymph node. This procedure identifies in a reliable way the sentinel node in most cases. The histological characteristics of the sentinel node reflect those of the rest of the axillary lymph nodes. This procedure appears more accurate for patients with tumors less than 20 mm. This procedure will become the method of choice for axillary staging in small-sized breast cancer. This minimally invasive procedure represents a major step in the field of breast cancer treatment. [Copyright &y& Elsevier]

Sentinel node (SN) biopsy in breast cancer is still in a crucial stage of evaluation. Many teams have obtained excellent results using this method, with a detection rate always higher than 90 % and a false negative rate between 0 and 8 %, in prospective series. The main question is to know if lymphadenectomy can now be avoided when the SN is negative. The answer will come from the results of the two ongoing trials comparing sentinel node biopsy to axillary lymphadenectomy. But their results will be available only in two or three years. However, many teams, as at Institut Gustave Roussy, are now applying the technique routinely, because of the excellent results obtained during their learning curve. But there are some methodological differences between teams, which can influence the detection and false negative rates. Thus, several methodological standards remain to be defined. This review enable us to clarify a certain number of questions. Today, SN biopsy can only be performed by trained teams, with prospective evaluation of their results or participation in phase III trials. [Copyright &y& Elsevier]

Sentinel lymph node biopsy (SLNB) has been initially developed for melanoma and breast cancers. Its application in head and neck cancers is recent, probably due to the complexity of the lymphatic drainage, the proximity between the primary tumor and the lymph nodes and the critical anatomical structures (such as the facial nerve). In onco-dermatology, SLNB is validated in head and neck surgery for melanoma with Breslow thickness up to 1mm or ulceration, Merkel carcinoma and high-risk squamous cell carcinoma. Considering the malignancies of the upper aerodigestive tract, the feasibility and oncologic safety of SLNB are now established for T1-T2N0 oral and oropharyngeal squamous cell carcinomas. Thus, it could allow patients with negative sentinel nodes to avoid an unnecessary neck dissection, leading to a decrease of morbidity with an quality of life improvement. For some primary locations (e.g., anterior floor of the mouth) with high proximity between tumor and lymph nodes, it is recommended to remove the tumor before the SLNB so as to improve the detection. New techniques of detection are currently being developed with intra-operative procedures and new tracers (such as tilmanocept), leading to a better accuracy of detection and, probably, new indications., (Copyright © 2019 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Sentinel node is defined as the first node to receive drainage from a primary tumor and seems to reflect the nodal status in the lymphatic drainage of the tumor. Sentinel node technique has modified the pathological examination of lymph nodes, with intraoperative evaluation of sentinel node, allowing immediate lymph node dissection in case of positive sentinel node, and histological ultrastratification to detect occult metastases. This is a literature review of different histological protocols of sentinel node according to different organs. Except for sentinel node in breast cancer and melanoma, intraoperative examination of sentinel node is helpful using frozen section, more sensitive than touch imprint cytology. Sentinel node should be embedded in paraffin block entirely after gross sectioning at two millimeters intervals parallel to the long axis of the node. Histological ultrastaging with serial sections can be helpful, but the number of sections and the interval between them is not codified. Three sections at 200-250 microns can identify the majority of micrometastases (<2mm and >200 microns). Systematic immunohistochemistry of sentinel node is not necessary for breast cancers, since isolated tumor cells do not modify the therapeutic strategy, but remains useful in other organs., (Copyright © 2019 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Improved knowledge of sentinel node procedures coupled with the results of adjuvant clinical trials in stage III melanoma have prompted the French Cutaneous Oncology Group to propose new guidelines for the management of stage III melanoma. These guidelines comply with the principles of the evidence-based medicine., (Copyright © 2019 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Improved knowledge of sentinel node procedures coupled with the results of adjuvant clinical trials in stage III melanoma have prompted the French Cutaneous Oncology Group to propose new guidelines for the management of stage III melanoma. These guidelines comply with the principles of the evidence-based medicine., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

The sentinel node has a fundamental role in the management of early breast cancer. Currently, the double detection of blue and radioisotope is recommended. But in common practice, many centers use a single method. However, with a single detection, the risk of false negatives and the identification failure rate increase to a significant extent and the number of sentinel lymph node detected and removed is not enough. Furthermore, the tracers used until now show inconveniences. The purpose of this work is to present a new method of detection, using the green of indocyanine coupled with fluorescence imaging, and to compare it with the already existing methods. The method combined by fluorescence and isotopic is reliable, sure, of fast learning and could constitute a good strategy of detection. The major interest is to obtain a satisfactory number of sentinel nodes. The profit could be even more important for overweight patients. The fluorescence used alone is at the moment not possible. Wide ranging studies are necessary. The FLUOTECH, randomized study of 100 patients, comparing the isotopic method of double isotope technique and fluorescence, is underway to confirm these data., (Copyright © 2016 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Sentinel node biopsy without complementary axillary lymph node dissection was validated for T1-2 N0 unifocal breast cancer without previous treatment since several years. In the situation of multifocal multicentric breast tumors, this procedure was considered as a contraindication. The aim of this work was to analyse literature results to determine if sentinel lymph node biopsy can be considered as a valid option without complementary axillary lymph node dissection for negative sentinel lymph node., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Objective: To evaluate the feasibility of the magnetic technique for sentinel node biopsy (SNB) in breast cancer., Patients and Methods: A total of 10 consecutives patients with breast cancer scheduled for SNB, who were clinically node negative, were recruited. SNB was undertaken after injection of both magnetic and radio-isotopic tracers., Results: One or more SN were identified among 10 patients (identification rate of 100%). The median number of GS taken was 1.7 (range 1-3). In total, 17 GS were taken. SN were radioactive and ferromagnetic (82.3%), 3 were only radioactive and none was only ferromagnetic., Discussion and Conclusion: The magnetic technique is feasible, but cannot be used alone due to technical constraints., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Contribution of axillary lymph node dissection (ALND) is questioned for positive sentinel node (SN), micro-metastasis and isolated tumor cells but also for macro-metastasis. The aim of this work is to precise why a prospective randomized trial is necessary and the design of this trial. Why? For positive SN, the scientific level evidence appears insufficient for validation of ALND omission as a new standard. Rational is presented with non-sentinel node involved rate and number of NSL involved at complementary ALND, axillary recurrence rate, disease free survival rate and adjuvant treatment decision impact. How? The proposed Sentinelle Envahi et Randomisation du Curage (SERC) trial will randomly assign to observation only or complementary ALND with positive SN. The aim is to demonstrate the non-inferiority of ALND omission versus ALND.

Introduction: The objective of the study was to determine the preferential territories of drainage of skin areas of the face and neck. This knowledge can guide the strategies of diagnostic (search for primary tumor skin to cervical lymphadenopathy) and treatment (determination of the extent of neck dissection to achieve in case of skin tumor)., Materials and Methods: This is a retrospective study of the surgical procedures of sentinel node research between January 2003 and April 2011. The lymphoscintigraphic and intraoperative localization of the initial tumor site and sentinel lymph node were collected., Results and Discussion: One hundred and thirty-seven patients were included in the study. The parotid gland is a privileged territory of drainage of the head and neck skin. At cervical level, the submental region drains the lower and median part of the face (lips and chin). The posterior segments (IIb and V sector) were represented for the posterior locations of the head (ear, vertex), and cervical region., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

A therapeutic surgical de-escalation has been observed since many years with an actual prolongation for axillary lymph node area treatment. Axillary lymph node dissection (ALND) omission has been studied before and after validation of sentinel node (SN) biopsy procedure. A non-inferiority of ALND omission has been reported in case of non-involved SN. ALND omission has been studied in case of SN involvement without consensus in relation with scientific level of proof and with selective indications. The purpose of this work is to make a synthesis of the experiences on this subject then to envisage the current and future perspectives.