Quels cancers gynécologiques peuvent bénéficier du sentinel node ?

Selon les recommandations Saint-Paul de Vence 2024-2025 guidelines, le sentinel node est indiqué dans les cancers de l'endomètre dans leurs formes précoces (y compris certaines formes à risque plus élevé), dans les cancers du col utérin de petite taille, et dans certains cancers de la vulve (ganglions inguinaux). Pour le cancer de l'ovaire, le sentinel node n'est pas une option validée et le lymphadenectomy n'est plus systématique selon les recommandations 2025.

How l'intervention se déroule-t-elle ?

L'intervention est réalisée sous anesthésie générale par voie laparoscopic ou robotique. Le traceur (vert d'indocyanine) est injecté dans le col utérin ou autour de la tumeur. Ae caméra fluorescente infrarouge identifie les sentinel nodes, qui sont prélevés bilatéralement. L'opération dure 90 à 150 minutes. L'hospitalisation est courte (1 nuit en général).

The sentinel node remplace-t-il systématiquement le lymphadenectomy ?

Pas toujours. Si le sentinel node est positif (envahi), un lymphadenectomy peut être indiqué dans certaines situations selon le type de cancer et le stade. Dans le cancer de l'endomètre, l'analyse du sentinel node permet une détection plus fine des micrométastases (ultrastaging) que le lymphadenectomy classique. Pour le cervical cancer, l'étude SHAPE 2024 a élargi les indications de l'hysterectomy simple (sans lymphadenectomy) pour les tumeurs de bon pronostic.

Qu'est-ce que le vert d'indocyanine (ICG) ?

Le vert d'indocyanine est un colorant fluorescent injectable, utilisé en routine en chirurgie hépatique et oncologique. Visible uniquement sous lumière infrarouge proche, il permet une cartographie en temps réel des canaux lymphatiques pendant l'opération. Il a remplacé progressivement le bleu patenté (qui colorait la patiente en bleu) et est combiné parfois au technétium radioactif pour optimiser la détection.

Quels sont les risques du pelvic sentinel node ?

Les risques sont ceux de la laparoscopy pelvienne : plaie urétérale (rare, moins de 1%), lymphocèle (collection lymphatique, 2-5%), saignement, infection. Comparé au lymphadenectomy, le risque de lymphœdème des membres inférieurs est divisé par 5 environ (passant de 10-20% à moins de 5%).

Combien de temps dure la récupération ?

La récupération est rapide grâce à la voie laparoscopic. Reprise des activités quotidiennes sous 7-10 jours, reprise du travail sous 2-3 semaines selon l'activité. No liftings lourdes pendant 4 semaines. Le résultat anatomopathologique est disponible sous 7-10 jours et présenté en RCP.

Y a-t-il une alternative si le sentinel node ne peut pas être identifié ?

Si l'identification du sentinel node échoue d'un côté (5-10% des cas), un lymphadenectomy pelvien limité homolatéral peut être réalisé. Si l'identification est bilatérale impossible (rare avec l'ICG), un lymphadenectomy pelvien bilatéral classique reste l'option de stadification de référence.

Pelvic sentinel node biopsy Paris — Dr Jérémie Zeitoun

Q: Qu'est-ce que le pelvic sentinel node ?

The pelvic sentinel node est le premier ganglion drainant la tumeur dans le bassin. On l'identifie grâce à un traceur (vert d'indocyanine fluorescent ou technétium radioactif) injecté autour de la tumeur. Si ce ganglion est indemne, le lymphadenectomy complet peut être évité, ce qui réduit considérablement le risque de leg lymphoedema.

Summary · 1 minute read

Pelvic sentinel node biopsy: key takeaways

→Definition. The sentinel node is the first node draining the tumour. When clear after pathological analysis, downstream nodes have a >95% probability of being clear too. This procedure is always combined with the main surgery on the affected organ (hysterectomy, conization, vulvectomy depending on cancer type) — it is never performed alone.
→Main indications. Cervical and endometrial cancers in their early stages. The Saint-Paul de Vence 2024-2025 guidelines guidelines have validated this technique, including for some higher-risk forms.
→Main benefit. When the sentinel node is clear, the full pelvic lymphadenectomy can be avoided. The risk of leg lymphoedema is therefore reduced by approximately five-fold compared to standard lymphadenectomy.
→Method. A fluorescent dye (indocyanine green, ICG) is injected into the cervix during surgery. It allows real-time visualisation of lymphatic channels and the sentinel node using a dedicated near-infrared camera.
→Procedure. Procedure under general anaesthesia, by laparoscopy or Da Vinci robot. Average one night hospital stay. Return to daily activities within 7 to 10 days.
→Ae technique fiable. Several international studies have shown that the diagnostic accuracy of sentinel node biopsy is equivalent to standard lymphadenectomy for these indications.

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%).

Indications cliniques

Pour quels cancers ?

The sentinel node is not indicated for all gynaecological cancers. The Saint-Paul de Vence 2024-2025 guidelines specify the situations in which this technique replaces standard lymphadenectomy.

Cervical cancer →

Validated indication for small tumours. This technique has been extensively studied and validated by the SENTICOL trials.

Associated procedure. The sentinel node biopsy accompanies the main procedure on the cervix: conisation, simple hysterectomy or radical hysterectomy depending on tumour size and extension. For tumours with a favourable prognosis, the SHAPE 2024 study made it possible to simplify surgery.

→ Learn more about cervical cancer

Uterine cancer →

Indication large. The sentinel node is now the reference technique for staging early-stage endometrial cancers, including some higher-risk forms according to 2024-2025 guidelines.

Associated procedure. Sentinel node biopsy always accompanies removal of the uterus, ovaries and tubes (total hysterectomy with bilateral salpingo-oophorectomy), performed by laparoscopy or robotically. For certain tumour types, omentectomy is added. The method has been validated by the FIRES study.

→ Learn more about uterine cancer

Vulvar cancer →

Anatomical specificity. Lymphatic drainage from the vulva first passes through the groin (inguinal) lymph nodes, not the pelvic lymph nodes.

Associated procedure. The inguinal sentinel node is associated with vulvar surgery (partial vulvectomy or hemivulvectomy), through an open approach. Technique validated by the GROINSS-V trial for small unifocal tumours.

→ Learn more about vulvar cancer

Ovarian cancer →

No validated indication. For ovarian cancer, the sentinel node technique is not validated in routine practice.

Approche alternative. The main surgical procedure is cytoreductive surgery. According to the Saint-Paul de Vence 2025 guidelines, lymphadenectomy is no longer systematic: it is now reserved for situations where suspicious lymph nodes are identified on imaging or during surgery.

→ Learn more about ovarian cancer

Surgical technique

Procedure de l'intervention

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 · cancer de la vulve · cancer de l'ovaire.

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

Injection du traceur

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

Cartographie fluorescente

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

Geste oncologique principal

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

Analyse anatomopathologique

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.

Recovery

Post-operative recovery

Recovery is facilitated by the minimally invasive approach (laparoscopic or robotic). The main stages of the post-operative pathway are as follows.

Jour 0 — Jour de l'intervention

Recovery in the post-anaesthesia care unit. Intravenous analgesia during the early hours. Out of bed by the evening. Early mobilisation and light diet.

Jour 1 — Sortie d'hospitalisation

Average overnight hospitalisation. Discharge after medical visit, urinary catheter removal,t reprise du transit. Relais antalgique par voie orale.

Days 2 to 7

Relative rest at home. Short walks recommended to prevent thromboembolic risk. No lifting over 5 kg. Simple wound care (dressings to be renewed every 2 to 3 days, then removed).

2-3 semaines

Return to work depending on the nature of the professional activity. Gradual resumption of light physical activity (walking, stationary bike) from the third week onwards.

Pathology result

Pathology results available within 7 to 10 days and presented at the gynaecological MDT. Results consultation scheduled 10 to 15 days after the procen.

Surveillance

Consultations every 4 months for the first year, then every 6 months up to 5 years. Clinical exam, cervical smear if the cervix is preserved, imaging per guidelines.

Risques et complications

The pelvic sentinel node technique reduces morbidity compared to standard lymphadenectomy, but it carries specific complications worth knowing. All are detailed in pre-operative consultation.

Laparoscopy-related risks

Organ injury (bowel, bladder, ureter): less than 1%. Intraoperative bleeding requiring transfusion: less than 2%. Conversion to laparotomy (open surgeryte) : moins de 3 %.

Pelvic lymphocele

Pelvic lymph collection: 2 to 5% of cases. Most often asymptomatic with spontaneous resolution. Drainage may be indicated for a large or symptomatic lymphocele.

Lower-limb lymphoedema

Risk reduced to less than 5% with sentinel node biopsy, versus 10 to 20% with standard lymphadenectomy. Onset may be delayed (months or years after the procedure). Management combines manual lymphatic drainage, multilayer bandaging and physiotherapy.

Failure to identify

The sentinel node is not identified in 5 to 10% of cases, most often unilaterally. In case of unilateral failure, a limited ipsilateral lymphadenectomy is performed. In case of bilateral failure (rare with experienced operators), a full pelvic lymphadenectomy is performed.

False negatives

Risk that a sentinel node appears clear while downstream nodes are involved: less than 5%. Ultrastaging with systematic immunohistochemistry specifically aims to minimiser ce risque.

Allergic reaction to tracer

Indocyanine green is generally well tolerated. Allergic risk is less than 1 in 10,000. Special precautions apply for patients with iodine allergy (presence of iodide in the formulation) — the anaesthesia consultation will assess these risks.

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)	Bonne (analyse standard)
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
Indication principale	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

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.
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.
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.
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.
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.
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.
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.
Clinical practice guidelines Nice/Saint-Paul-de-Vence 2024-2025: management of localised cervical cancer. Bull Cancer. 2026. ScienceDirect.
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.
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 sur le 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.

Qu'est-ce que le pelvic sentinel node exactement ?▾

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 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.

Qu'est-ce que le 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).

Combien de temps dure l'hospitalisation ?▾

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.

The sentinel node remplace-t-il toujours le 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).

Based on your situation

Pelvic sentinel node biopsy is part of the comprehensive management of a gynaecological cancer. To better understand your situation, please refer to the dedicated cancer page.

Alternative technique

Pelvic & para-aortic lymphadenectomy →

Vue d'ensemble

All gynaecological cancers →

Consultation et second avis

Échanger sur votre 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

Pelvic sentinel node Dr Jérémie Zeitoun · Cervical and endometrial cancer

Pelvic sentinel node biopsy: key takeaways

Why cette approche has transformed management

Pour quels cancers ?

Cervical cancer →

Uterine cancer →

Vulvar cancer →

Ovarian cancer →

Procedure de l'intervention

Preparation and anaesthesia

Injection du traceur

Cartographie fluorescente

Careful dissection

Geste oncologique principal

Analyse anatomopathologique

Post-operative recovery

Risques et complications

Laparoscopy-related risks

Pelvic lymphocele

Lower-limb lymphoedema

Failure to identify

False negatives

Allergic reaction to tracer

Sentinel node vs lymphadenectomy

Scientific references

Frequently asked questions sur le pelvic sentinel node

Based on your situation

Échanger sur votre situation

Transparent pricing

Pelvic and para-aortic lymphadenectomy