EC Gynaecology

Introduction: Breast cancer screening has led to the increasingly frequent discovery of smaller sized cancers. These tumors have a low lymph node metastatic potential, hence the introduction of the sentinel lymph node (SLN) technique to determine axillary lymph node involvement. The sentinel lymph node is the first lymph node affected by metastatic cells from a primary tumor. Its excision, a less morbid technique, makes it possible to reliably establish the lymph node status of breast cancer. Thus, it selects patients who, having occult lymph node metastases with regard to the clinico-radiological evaluation, could benefit from adjuvant regional or systemic treatment. The first techniques to remove this lymph node were based on standard anatomical models and never replaced classic lymphadenectomies. The development of more functional pre- and intraoperative lymphatic mapping techniques in the 1990s then made it possible to validate the concept of sentinel lymph node as an alternative to lymph node dissection. This article describes the experience of the obstetrics and gynecology department 2 with the sentinel lymph node and the results are compared to those found in the literature.

Objectives: Report the results of the SLN technique in breast cancer at the GOII department within the HASSAN II University Hospital of FES.

Materials and Methods: This is a retrospective study between January 2022 and February 2024 during which 35 patients with breast cancer were included. All these women had a SLN search using a combined method.

Results: The detection rate was 97.6% (n = 33). An extemporaneous examination was carried out in all patients. The average number of lymph nodes collected was three (ranging from one to five). The sensitivity of the extemporaneous examination was 95.7%. No false positives were found on extemporaneous examination. The SLN was invaded in 04 patients (9.5%) completed by an axillary dissection.

Conclusion: The SLN technique is a reliable and feasible technique. However, it requires training from the surgeon, the pathologist and the nuclear doctor. It helps reduce the morbidity of breast cancer treatment by avoiding “unnecessary” lymph node dissections in patients without lymph node involvement. The increase in the number of smaller sized cancers discovered during screening makes it possible to increase the number of patients who can benefit from this technique.

 Keywords: Sentinel Lymph Node Technique; Breast Cancer

1. Schwartz GF., et al. “Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast April 19 to 22, 2001, Philadelphia, Pennsylvania”. Human Pathology6 (2002): 579-589.
2. Bobin JY., et al. “[Lymph node mapping and axillary sentinel lymph node biopsy in 243 invasive breast cancers with no palpable nodes. The south Lyon hospital center experience]”. Annales de Chirurgie9 (2000): 861-870.
3. N Hoen., et al. “Intérêt de l’examen extemporané du ganglion sentinelle dans le cancer du sein. Etude rétrospective sur 293 patientes”. Gynécologie Obstétrique & Fertilité5 (2016): 274-279.
4. Tafra L., et al. “Multicenter trial of sentinel node biopsy for breast cancer using both technecium sulfur colloid and isosulfan blue dye”. Annals of Surgery1 (2001): 51-59.
5. Saint-Paul de Vence. Recommendations pour la pratique clinique “Cancer du sein”: Le traitement de l’aisselle 2005TLSTPAUL270705.doc: 10-26.
6. Cox CE., et al. “Learning curves for breast cancer sentinel lymph node mapping based on surgical volume analysis”. Journal of the American College of Surgeons 6 (2001): 593-600.
7. Helyer LK., et al. “Obesity is a risk factor for developing postoperative lymphedema in breast cancer patients”. Breast Journal 1 (2010): 48-54.
8. Murawa D., et al. “Sentinel lymph node biopsy in breast cancer guided by indocyanine green fluorescence”. British Journal of Surgery 11 (2009): 1289-1294.
9. Zhixian He., et al. “Clinical value of postoperative sentinel lymph node biopsy”. Annals of Translational Medicine 22 (2019): 683.
10. Mc-Masters KM., et al. “Defining the optimal surgeon experience for breast cancer sentinel lymph node biopsy: a model for implementation of new surgical techniques”. Annals of Surgery 3 (2001): 292-300.
11. McMasters KM., et al. “Sentinel lymph node biopsy for breast cancer: a suitable alternative to routine axillary dissection in multi-institutional practice when optimal technique is used”. Journal of Clinical Oncology 13 (2000): 2560-2566.
12. Boughey JC., et al. “Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node- positive breast cancer the ACOSOG Z1071 (Alliance) clinical trial”. The Journal of the American Medical Association 14 (2013): 1455-1461.
13. Barranger E., et al. “Sentinel lymph node biopsy in breast cancer: technical aspects and results”. Annales de Chirurgie3 (2003): 144-149.
14. Schijven MP., et al. “Comparison of morbidity between axillary lymph node dissection and sentinel node biopsy”. European Journal of Surgical Oncology (EJSO)4 (2003): 341-350.