The concept of the sentinel node: A revolution in the management of lymph node invasion - review article with a focus in breast cancer

The sentinel node is the first lymph node reached by metastatic cells from a primary tumor. Its resection is a minimally invasive technique which can make it possible to select patients who, having occult lymph node metastases, could benefit from adjuvant regional orsystemic treatment. The first attempts to remove this node were based on standard anatomical models and never replaced classical lymphadenectomies. The development of more fonctional pre- and intraoperative lymphatic mapping techniques in the 1990s, on the other hand, made it possible to validate the concept of a sentinel node as an alternative to dissection. The hypothesis of sequential tumor dissemination and the concept of the first filter have been validated innumerous studies of sentinel lymph node biopsy with regional lymph node dissection for confirmatory purposes. This paper reviews the history and validation of the technique, its lessons and its perspectives, with a particular focus on breast cancer. (C) 2022 l'Academie nationale de medecine. Published by Elsevier Masson SAS. All rights reserved.