Sentinel lymph node

For 20 years, the sentinel lymph node technique has been developed in cervical cancer and our team has played a major role in its development [Lécuru et al, Journal of Clinical Oncology 2011].

This aims to replace pelvic lymph node dissection.

The principle of the technique is to inject a tracer into the cervix and to remove the first marked lymph nodes. If they are unharmed, the risk of having an attack in another lymph node is very low.
This makes it possible to remove fewer nodes and reduce the morbidity of lymph node removal. Conventional dissections are indeed responsible for lymphedema or lymphocele (see chapter on complications of dissections) in more than 15% of cases (Mathevet P & al).

This technique has other advantages. The very fine analysis of a small number of lymph nodes makes it possible to diagnose metastases of very small volume. Patients considered to be free of lymph node metastases thus have a rectified diagnosis and better quality care.
Finally, this technique makes it possible to locate drainage lymph nodes in unusual anatomical territories. It has long been known that lymphatic drainage can occur in unusual territories in 15 to 20% of cases. This technique makes it possible to identify them and provides better quality information.

To identify these lymph nodes, we used for a long time the combination of an isotope and a dye, Patent Blue.

Today, fluorescence makes it possible to be more effective, with less constraint for the patient and at a lower cost. Many studies have now reported the superiority of this technique over the combined method of the 2000s.
The sentinel lymph node technique is validated for many cancers, such as breast cancer, vulvar cancer, melanoma, etc.
It is not for cervical cancer. A protocol, SENTICOL III, is currently underway in France and other countries to verify that 'there is no loss of chance in terms of survival. The data currently available are reassuring, but need to be confirmed.