Home
Breast & breast cancer
Breast cancer Benign breast lesions Prophylactic mastectomy
Breast reconstruction
All techniques Implant reconstruction Latissimus dorsi flap DIEP flap (abdomen) Gracilis flap (thigh) Fat grafting (lipofilling) Flat closure Intimate surgery
Benign gynaecological surgery
Uterus Ovaries and tubes Cervix Vulva and vagina
Gynaecological cancers
Cervical cancer Ovarian cancer Uterine cancer Vulvar cancer Borderline tumours Articles About
Request a callback Book on Doctolib →
Pelvic sentinel node biopsy — Dr Jérémie Zeitoun chirurgien cancérologue gynécologue Paris
Logo Dr J. Zeitoun
Gynaecological oncologic surgery · Paris 8th & Neuilly

Pelvic sentinel node Dr Jérémie Zeitoun · Cervical and endometrial cancer

A less invasive alternative to lymphadenectomy that reduces complications while preserving diagnostic accuracy. Aderstanding this technique and its indications.

Dr Jérémie Zeitoun chirurgien Paris
Scroll down

Summary · 1 minute read

Pelvic sentinel node biopsy: key takeaways

Comprendre

Why cette approche has transformed management

For decades, lymph node staging of pelvic gynaecological cancers relied on the systematic removal of the entire lymph node chain — lymphadenectomy. This extensive dissection exposes patients to a risk of lower-limb lymphoedema, a potentially long-lasting and disabling complication. The sentinel node has profoundly changed this approach.

The principle is physiological. The lymphatic spread of a tumour follows a precise anatomical pathway, reaching first the primary draining node — the sentinel node. When this node is clear after fine pathological analysis, the downstream nodes have a probability greater than 95% of also being clear. The targeted removal of the sentinel node alone is then sufficient, without needing to access the rest of the chain.

More sensitive pathological analysis. Standard lymphadenectomy involves analysis of 15 to 30 nodes by standard sections. The sentinel node surgical technique targets 2 to 4 nodes, examined in ultrastaging: serial sections every 200 microns with immunohistochemistry for cytokeratin staining. This method detects micrometastases (0.2 to 2 mm) and isolated tumour cells that could escape the standard analysis of a lymphadenectomy.

Patient benefits. Reduction of immediate sequelae (lower incidence of extensive pelvic lymphocele), shorter operative time, reduced hospital stay. The major benefit remains the reduction of lower limb lymphoedema risk, reduced by approximately five-fold compared to classic lymphadenectomy (from 10-20% to less than 5%).

Clinical indications

For which cancers?

The pelvic sentinel node is now the reference technique for two gynaecological cancers according to the Saint-Paul de Vence 2024-2025 guidelines. For ovarian cancer, management relies on cytoreductive surgery and a targeted lymphadenectomy in case of suspicious nodes.

Validated indication
Early tumours

Cervical cancer

Technique extensively studied and validated by the SENTICOL trials for small tumours. For favourable-prognosis tumours, the SHAPE 2024 trial simplified surgery.

Associated procedure: conisation, simple hysterectomy or radical hysterectomy depending on tumour size and extension.

Learn more about cervical cancer
2025 reference
Reference staging

Endometrial cancer

The sentinel node is now the reference technique for staging early endometrial cancers, including some higher-risk forms. Validated by the FIRES trial.

Associated procedure: total hysterectomy with bilateral salpingo-oophorectomy, by laparoscopy or robot. Omentectomy added for certain histological types.

Learn more about uterine cancer
Surgical technique

Procedure overview

The procedure follows a precise surgical sequence. The major evolution of recent years has been the introduction of indocyanine green, a fluorescent dye that has progressively replaced patent blue due to its better performance and lower allergenicity.

A procedure always associatedThe pelvic sentinel node biopsy is never performed alone. It is an integral part of the main surgical procedure for the cancer concerned — removal of the uterus for endometrial and cervical cancers, conisation or hysterectomy depending on tumour size. The sentinel node biopsy is performed during the same operation, under the same anaesthesia. Depending on the cancer involved : cervical cancer · uterine cancer.

1

Preparation and anaesthesia

General anaesthesia, supine position with thighs flexed (lithotomy position). Placement of 4 to 5 laparoscopic trocars (5 to 10 mm incisions). For the robotic approach, the Da Vinci system is docked with the patient.

2

Tracer injection

For endometrial cancer: intracervical injection (into the cervix) of 1 to 2 mL of indocyanine green at 1.25 mg/mL, at 4 points (3, 6, 9 and 12 o'clock). For cervical cancer: peritumoral injection with optional additional injection in some protocols.

3

Fluorescent mapping

The laparoscopic camera is switched to near-infrared fluorescence mode. Lymphatic channels then appear in green on the image. The trajectory is followed up to the first illuminating node — the sentinel node.

4

Careful dissection

The sentinel node is carefully dissected, respecting neighbouring structures (ureter, iliac vessels). It is extracted in a protective bag to prevent contamination. If identification fails on one side, a limited ipsilateral lymphadenectomy is performed.

5

Main oncological procedure

Depending on the cancer: total hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer, conization or hysterectomy for cervical cancer. The minimally invasive approach is preferred for stages I-II. The entire procedure takes 2 to 3 hours on average.

6

Pathology analysis

The sentinel node(s) are analysed by ultrastaging: serial sections every 200 microns, immunohistochemistry with AE1/AE3 cytokeratin staining. This detailed analysis detects micrometastases (0.2-2 mm) and isolated tumour cells (<0.2 mm) that would have escaped standard analysis.

Post-operative recovery

Post-operative recovery

Recovery is facilitated by the minimally invasive approach (laparoscopic or robotic). Short hospital stay, fast return to normal life. Here are the main stages of post-operative care.

01
Day 0 — Surgery

The day of surgery

Recovery in the post-anaesthesia care unit. Intravenous analgesia for the first hours. Sitting up in a chair the same evening and early mobilisation with light meal.

02
Day 1 — Discharge

Short hospital stay

One night on average. Discharge after medical review, urinary catheter removal and bowel transit recovery. Switch to oral analgesia.

03
Days 2-7

Relative rest at home

Short walks recommended to prevent thromboembolic risk. No lifting more than 5 kg. Simple wound care (dressings every 2-3 days, then removal).

04
2-3 weeks

Progressive resumption

Return to work depending on the nature of the professional activity. Progressive resumption of gentle physical activity (walking, stationary cycling) from the third week.

05
10-15 days

Pathology results

Results available within 7 to 10 days and presented at gynaecological MDT. Results consultation scheduled 10 to 15 days after surgery.

06
Follow-up

Long-term monitoring

Consultations every 4 months in the first year, then every 6 months up to 5 years. Clinical examination, cervical smear if cervix preserved, imaging according to guidelines.

Risks and complications

Risks and complications

The pelvic sentinel node technique reduces morbidity compared with classic lymphadenectomy, but specific complications must be understood. All are detailed during the pre-operative consultation.

⚕
<3%

Laparoscopic risks

Organ injury (bowel, bladder, ureter): less than 1%. Intra-operative bleeding requiring transfusion: less than 2%. Conversion to laparotomy: less than 3%.

◎
2-5%

Pelvic lymphocele

Lymph collection in the pelvis: 2 to 5% of cases. Most often asymptomatic with spontaneous resolution. Drainage may be needed for large or symptomatic lymphocele.

↓
<5%

Lower limb lymphoedema

Risk reduced to less than 5% with sentinel node, vs 10-20% with classic lymphadenectomy. Onset may be delayed. Management: manual lymphatic drainage + compression stockings.

⊘
5-10%

Identification failure

The sentinel node is not identified in 5 to 10% of cases, most often unilateral. Unilateral failure: limited ipsilateral lymphadenectomy. Bilateral failure (rare with ICG): classic lymphadenectomy.

!
<5%

False negatives

Risk that a sentinel node appears clear while downstream nodes are involved: less than 5%. Ultrastaging with systematic immunohistochemistry aims precisely to minimise this risk.

✚
<0.01%

Allergic reaction to tracer

Indocyanine green is generally well tolerated. Allergic risk: less than 1 case per 10,000. Particular caution in patients allergic to iodine (traces of iodine in ICG).

Comparison

Sentinel node vs lymphadenectomy

The direct comparison of the two approaches helps understand why sentinel node biopsy has become the reference for early-stage staging.

Criterion Sentinel node Pelvic lymphadenectomy
Number of nodes removed 2 to 4 15 to 30
Diagnostic accuracy Higher (ultrastaging) Good (standard analysis)
Lymphoedema risk < 5% 10 to 20%
Operating time (lymph node procedure alone) 30 to 45 min 60 to 90 min
Hospitalisation 1 nuit 2 to 4 nights
Full recovery 2 to 3 weeks 4 to 6 weeks
Main indication Early stages (FIGO I-II) Advanced stages or ovary
Recommandation Saint-Paul de Vence 2025 Reference (early cervical, endometrium I-II) Reference (ovary, advanced stages)

For staging of advanced cancers or ovarian cancer, see the dedicated page on pelvic and para-aortic lymphadenectomy.

References & sources scientifiques

Scientific references

  1. Lecuru F, Mathevet P, Querleu D, et al. Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: results of the SENTICOL study. J Clin Oncol. 2011;29(13):1686-1691. PMID 21444878.
  2. Mathevet P, Lecuru F, Uzan C, et al. Sentinel lymph node biopsy and morbidity outcomes in early cervical cancer: the SENTICOL-2 randomised trial. Eur J Cancer. 2021;148:307-315. PMID 33773275.
  3. Plante M, Kwon JS, Ferguson S, et al. Simple versus radical hysterectomy in low-risk early-stage cervical cancer (SHAPE trial). N Engl J Med. 2024;390(9):819-829. PMID 38416429.
  4. Rossi EC, Kowalski LD, Scalici J, et al. A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial). Lancet Oncol. 2017;18(3):384-392. PMID 28159465.
  5. Concin N, Matias-Guiu X, Vergote I, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer. 2021;31(1):12-39. PMID 33397713.
  6. Cibula D, Pötter R, Planchamp F, et al. The European Society of Gynaecological Oncology / European Society for Radiotherapy and Oncology / European Society of Pathology guidelines for the management of patients with cervical cancer. Int J Gynecol Cancer. 2018;28(4):641-655. PMID 29688967.
  7. Bourgin C, Gillot D, Vidal F, et al. Clinical practice guidelines Nice/Saint-Paul-de-Vence 2022-2023: management of localised uterine cancer. Bull Cancer. 2023;110(6S):6S20-6S33. PMID 37573036.
  8. Clinical practice guidelines Nice/Saint-Paul-de-Vence 2024-2025: management of localised cervical cancer. Bull Cancer. 2026. ScienceDirect.
  9. Van der Zee AG, Oonk MH, De Hullu JA, et al. Sentinel node dissection is safe in the treatment of early-stage vulvar cancer (GROINSS-V). J Clin Oncol. 2008;26(6):884-889. PMID 18281661.
  10. Institut National du Cancer. Gynaecological cancers — Management guidelines. INCa, 2024. Available at e-cancer.fr.

This page is for informational purposes and does not replace individualised medical consultation. Page authored and medically reviewed by Dr Jérémie Zeitoun. Last updated: 8 May 2026.

Frequently asked questions

Frequently asked questions about pelvic sentinel node

The most frequently asked questions by patients, covering the different steps of care. Any additional question can be answered in pre-operative consultation.

What exactly is the pelvic sentinel node?▾
It is the first lymph node draining the tumour in the pelvis. Lymphatic tumour spread follows a precise anatomical pathway, first reaching this so-called "sentinel" node. If this node is clear after analysis, downstream nodes have a >95% probability of also being clear, eliminating the need for full lymphadenectomy.
For which cancers is the sentinel node indicated?▾
According to the Saint-Paul de Vence 2024-2025 guidelines, sentinel node biopsy is indicated for early-stage endometrial cancers (including some higher-risk forms) and early-stage cervical cancers (IA-IB1). For vulvar cancer, a slightly different technique is used with the tracer injected around the lesion.
What is indocyanine green (ICG)?▾
Indocyanine green is an injectable fluorescent dye, routinely used in hepatic and oncologic surgery. Invisible to the naked eye, it emits green fluorescence under near-infrared light, allowing real-time visualisation of lymphatic channels during surgery.
How does the procedure take place ?▾
Under general anaesthesia, by laparoscopy or Da Vinci robot. The tracer is injected into the cervix, then the bilateral sentinel nodes are identified by fluorescence. They are carefully excised before performing the main procedure (hysterectomy, conization depending on the cancer).
How long is the hospital stay?▾
One night on average when the procedure is performed laparoscopically or robotically. Discharge the next morning after medical visit, urinary catheter removal and bowel transit recovery. Home recovery is shorter than with a full lymphadenectomy.
Does the sentinel node always replace lymphadenectomy?▾
No, not systematically. If the sentinel node is positive (tumour cells present), a complementary lymphadenectomy may be indicated depending on the cancer type and context. For uterine cancer, ultrastaging analysis can detect micrometastases that would have escaped standard analysis, allowing better adaptation of adjuvant treatment.
What is the risk of leg lymphoedema ?▾
With sentinel node biopsy, this risk is below 5%. With standard pelvic lymphadenectomy, it is 10 to 20%. This difference represents one of the major benefits of the technique. Leg lymphoedema can be permanent and significantly impact quality of life, hence the importance of avoiding it whenever possible.
What happens if the sentinel node is involved?▾
The course of action depends on the cancer type. For uterine cancer, lymph node involvement modifies post-operative treatment, most often toward chemoradiotherapy. For cervical cancer, it usually means combining surgery with adjuvant chemoradiotherapy. The decision is made at the multidisciplinary team meeting (MDT).
What are the risks of the procedure?▾
Like any surgical procedure, pelvic sentinel node biopsy carries risks: organ injury (bowel, bladder, ureter) below 1%, bleeding requiring transfusion below 2%, conversion to laparotomy below 1%. The technique is mature and standardised in expert hands. All risks are detailed during the pre-operative consultation.
Why consult Dr Zeitoun for this procedure?▾
Dr Zeitoun is a gynaecological and breast surgical oncologist, trained at Institut Gustave Roussy (European reference centre in gynaecological oncology) and at Institut Curie. He performs the pelvic sentinel node technique using ICG via laparoscopic and robotic approaches. All therapeutic decisions are validated in multidisciplinary tumour boards (MDT). Clinic in Paris 8th district (241 rue du Faubourg Saint-Honoré), operating theatre at Clinique Hartmann (Neuilly-sur-Seine).
Further reading

Based on your situation

The pelvic sentinel node is part of the overall management of a gynaecological cancer. Read the page dedicated to your situation to understand the full pathway.

01 Validated indication

Cervical cancer

Small early tumours. Validated by the SENTICOL trials and the SHAPE 2024 study.

Staging · Surgery Read page → 02 2025 reference

Endometrial cancer

Reference technique for early stages. Validated by the FIRES trial.

Staging · Hysterectomy Read page → 03 Alternative technique

Pelvic and para-aortic lymphadenectomy

The classic alternative. More extensive, more invasive — reserved for specific situations.

Compare · Advanced staging Compare both → 04 Overview

All gynaecological cancers

Pathway, treatments, team, comprehensive management of gynaecological cancers.

Pillar page · Overview View pillar →
Consultation and second opinion

Discuss your situation

For a first or second opinion regarding the management of a cervical or endometrial cancer, you can book an appointment with Dr Zeitoun. Teleconsultation is available for international patients.

Book an appointment +33 1 58 05 11 24

241 rue du Faubourg Saint-Honoré, 75008 Paris  ·  Clinique Hartmann, 92200 Neuilly-sur-Seine

Honoraires & Remboursements

Transparent pricing

Dr Zeitoun practises in sector 2 without OPTAM agreement and applies extra fees for all consultations and procedures. The French national health insurance reimburses based on the agreed convention rates. Complementary health insurance (mutuelle) may cover the difference depending on the policy.

Extra fees
Dr Zeitoun applies extra fees — including for patients with ALD (long-term illness) status. A detailed estimate is systematically provided before any procedure. No estimate is established without prior consultation.
Complementary health insurance
Your complementary health insurance may cover all or part of the extra fees depending on your policy. Do not hesitate to enquire with your insurer.
Related reading
Cervical cancer
Surgery & treatment
Read article →
Uterine cancer
Endometrial cancer surgery
Read article →
Pelvic & para-aortic lymphadenectomy
Indications & technique
Read article →
FREN