{"entity":{"id":"sentinel-node","kind":"technology","name":"Sentinel lymph node biopsy","aka":[],"tldr":"Removing just the first lymph node a tumour drains to, instead of all of them, to check for spread.","summary":"Sentinel lymph node biopsy injects a tracer (radiocolloid, blue dye, ICG, or magnetic particles) at the tumour to identify the first draining node, which is removed and examined instead of clearing the whole nodal basin. It is standard in breast cancer and melanoma and replaced full node dissection for most patients after Z0011 and AMAROS showed that omitting completion dissection did not compromise outcomes. The main benefit is avoiding lymphoedema from full dissection. It is now being omitted entirely in low-risk breast cancer (SOUND, INSEMA trials), an example of surgical de-escalation driven by better systemic therapy and imaging. False negatives occur in roughly 5-10% of cases, which is the accepted trade-off. The simple version is that surgeons check the one node most likely to harbour spread rather than removing them all.","status":"standard-of-care","asOf":"2026-09-04","wikipedia":"https://en.wikipedia.org/wiki/Sentinel_lymph_node","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Sentinel_lymph_node"}],"tags":[],"related":[],"cancers":["tnbc","breast-hr-positive","melanoma","breast-cancer"],"sections":["surgery"],"technologies":[],"targets":[],"drugs":["technetium-sulfur-colloid"],"companies":[],"institutions":[],"pathways":[],"terms":["axillary-surgery-de-escalation","targeted-axillary-dissection"],"trials":["nsabp-b32","sound","insema","senomac"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Tracer (radiocolloid, blue dye, ICG, magnetic) injected at tumour identifies draining node.","strengths":["Avoids lymphoedema from full dissection"],"limitations":["False negatives in ~5-10%"]},"route":"/technologies/sentinel-node/","neighbours":{"cancer":[{"id":"acral-melanoma","kind":"cancer","name":"Acral melanoma","route":"/cancers/acral-melanoma/"},{"id":"adenoid-cystic-carcinoma-breast","kind":"cancer","name":"Adenoid cystic carcinoma of the breast","route":"/cancers/adenoid-cystic-carcinoma-breast/"},{"id":"advanced-cutaneous-scc","kind":"cancer","name":"Advanced cutaneous squamous cell carcinoma","route":"/cancers/advanced-cutaneous-scc/"},{"id":"breast-cancer","kind":"cancer","name":"Breast cancer (all types)","route":"/cancers/breast-cancer/"},{"id":"cervical","kind":"cancer","name":"Cervical cancer","route":"/cancers/cervical/"},{"id":"cutaneous-scc","kind":"cancer","name":"Cutaneous squamous cell carcinoma","route":"/cancers/cutaneous-scc/"},{"id":"ductal-carcinoma-in-situ","kind":"cancer","name":"Ductal carcinoma in situ (DCIS)","route":"/cancers/ductal-carcinoma-in-situ/"},{"id":"early-cervical-cancer","kind":"cancer","name":"Early cervical cancer and fertility-sparing surgery","route":"/cancers/early-cervical-cancer/"},{"id":"her2-positive-early-breast-cancer","kind":"cancer","name":"Early HER2-positive breast cancer","route":"/cancers/her2-positive-early-breast-cancer/"},{"id":"tnbc-early","kind":"cancer","name":"Early triple-negative breast cancer","route":"/cancers/tnbc-early/"},{"id":"endometrial","kind":"cancer","name":"Endometrial cancer","route":"/cancers/endometrial/"},{"id":"endometrial-nsmp","kind":"cancer","name":"Endometrial cancer with no specific molecular profile","route":"/cancers/endometrial-nsmp/"},{"id":"epithelioid-sarcoma","kind":"cancer","name":"Epithelioid sarcoma","route":"/cancers/epithelioid-sarcoma/"},{"id":"head-and-neck","kind":"cancer","name":"Head and neck squamous cell carcinoma","route":"/cancers/head-and-neck/"},{"id":"hr-positive-early-high-risk","kind":"cancer","name":"High-risk early HR-positive breast cancer","route":"/cancers/hr-positive-early-high-risk/"},{"id":"hpv-associated-vulvar-cancer","kind":"cancer","name":"HPV-associated vulvar squamous cell carcinoma","route":"/cancers/hpv-associated-vulvar-cancer/"},{"id":"hpv-independent-vulvar-cancer","kind":"cancer","name":"HPV-independent vulvar squamous cell carcinoma (p53-mutant)","route":"/cancers/hpv-independent-vulvar-cancer/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"lip-cancer","kind":"cancer","name":"Lip cancer","route":"/cancers/lip-cancer/"},{"id":"localised-penile-cancer","kind":"cancer","name":"Localised penile cancer (organ-confined, node-negative)","route":"/cancers/localised-penile-cancer/"},{"id":"male-breast-cancer","kind":"cancer","name":"Male breast cancer","route":"/cancers/male-breast-cancer/"},{"id":"melanoma","kind":"cancer","name":"Melanoma","route":"/cancers/melanoma/"},{"id":"merkel-cell-carcinoma","kind":"cancer","name":"Merkel cell carcinoma","route":"/cancers/merkel-cell-carcinoma/"},{"id":"metaplastic-breast-carcinoma","kind":"cancer","name":"Metaplastic breast carcinoma","route":"/cancers/metaplastic-breast-carcinoma/"},{"id":"node-positive-penile-cancer","kind":"cancer","name":"Node-positive and metastatic penile cancer","route":"/cancers/node-positive-penile-cancer/"},{"id":"oral-tongue-cancer","kind":"cancer","name":"Oral tongue and floor of mouth cancer","route":"/cancers/oral-tongue-cancer/"},{"id":"endometrial-p53-abnormal","kind":"cancer","name":"p53-abnormal endometrial cancer, including uterine serous carcinoma","route":"/cancers/endometrial-p53-abnormal/"},{"id":"paget-disease-of-the-nipple","kind":"cancer","name":"Paget disease of the nipple","route":"/cancers/paget-disease-of-the-nipple/"},{"id":"penile","kind":"cancer","name":"Penile cancer","route":"/cancers/penile/"},{"id":"endometrial-pole-ultramutated","kind":"cancer","name":"POLE-ultramutated endometrial cancer","route":"/cancers/endometrial-pole-ultramutated/"},{"id":"secretory-carcinoma-breast","kind":"cancer","name":"Secretory carcinoma of the breast","route":"/cancers/secretory-carcinoma-breast/"},{"id":"stage-ii-melanoma","kind":"cancer","name":"Stage IIB and IIC melanoma","route":"/cancers/stage-ii-melanoma/"},{"id":"stage-iii-melanoma","kind":"cancer","name":"Stage III melanoma (after surgery)","route":"/cancers/stage-iii-melanoma/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"},{"id":"uterine-carcinosarcoma","kind":"cancer","name":"Uterine carcinosarcoma","route":"/cancers/uterine-carcinosarcoma/"},{"id":"vulvar","kind":"cancer","name":"Vulvar cancer","route":"/cancers/vulvar/"}],"section":[{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"}],"drug":[{"id":"hexaminolevulinate","kind":"drug","name":"Hexaminolevulinate","route":"/drugs/hexaminolevulinate/"},{"id":"technetium-sulfur-colloid","kind":"drug","name":"Technetium Tc-99m sulfur colloid","route":"/drugs/technetium-sulfur-colloid/"},{"id":"tilmanocept-tc99m","kind":"drug","name":"Technetium-99m tilmanocept","route":"/drugs/tilmanocept-tc99m/"}],"term":[{"id":"axillary-surgery-de-escalation","kind":"term","name":"Doing less to the armpit","route":"/terms/axillary-surgery-de-escalation/"},{"id":"lymph-node","kind":"term","name":"Lymph node","route":"/terms/lymph-node/"},{"id":"sentinel-lymph-node-biopsy","kind":"term","name":"Sentinel node biopsy","route":"/terms/sentinel-lymph-node-biopsy/"},{"id":"targeted-axillary-dissection","kind":"term","name":"Targeted axillary dissection","route":"/terms/targeted-axillary-dissection/"}],"trial":[{"id":"acosog-z0011","kind":"trial","name":"ACOSOG Z0011 (Alliance)","route":"/trials/acosog-z0011/"},{"id":"acosog-z1071","kind":"trial","name":"ACOSOG Z1071 (Alliance)","route":"/trials/acosog-z1071/"},{"id":"almanac","kind":"trial","name":"ALMANAC (Axillary Lymphatic Mapping Against Nodal Axillary Clearance)","route":"/trials/almanac/"},{"id":"amaros","kind":"trial","name":"AMAROS (EORTC 10981-22023)","route":"/trials/amaros/"},{"id":"atnec","kind":"trial","name":"ATNEC","route":"/trials/atnec/"},{"id":"elective-neck-dissection-tmh","kind":"trial","name":"Elective vs therapeutic neck dissection in node-negative oral cancer (Tata Memorial)","route":"/trials/elective-neck-dissection-tmh/"},{"id":"fires-sentor","kind":"trial","name":"FIRES & SENTOR (sentinel node mapping)","route":"/trials/fires-sentor/"},{"id":"ibcsg-23-01","kind":"trial","name":"IBCSG 23-01","route":"/trials/ibcsg-23-01/"},{"id":"insema","kind":"trial","name":"INSEMA (Intergroup Sentinel Mamma)","route":"/trials/insema/"},{"id":"mslt-ii","kind":"trial","name":"MSLT-II","route":"/trials/mslt-ii/"},{"id":"nsabp-b32","kind":"trial","name":"NSABP B-32","route":"/trials/nsabp-b32/"},{"id":"posnoc","kind":"trial","name":"POSNOC","route":"/trials/posnoc/"},{"id":"senomac","kind":"trial","name":"SENOMAC","route":"/trials/senomac/"},{"id":"senticol-iii","kind":"trial","name":"SENTICOL III","route":"/trials/senticol-iii/"},{"id":"sound","kind":"trial","name":"SOUND (Sentinel Node vs Observation After Axillary Ultra-Sound)","route":"/trials/sound/"},{"id":"targeted-axillary-dissection-md-anderson","kind":"trial","name":"Targeted axillary dissection (MD Anderson prospective study)","route":"/trials/targeted-axillary-dissection-md-anderson/"}],"pairing":[{"id":"neoadjuvant-io-response-adapted","kind":"pairing","name":"Neoadjuvant immunotherapy → response-adapted adjuvant","route":"/pairings/neoadjuvant-io-response-adapted/"}],"institution":[{"id":"esso","kind":"institution","name":"European Society of Surgical Oncology","route":"/institutions/esso/"},{"id":"ieo-milan","kind":"institution","name":"IEO (European Institute of Oncology)","route":"/institutions/ieo-milan/"},{"id":"keio-university-hospital","kind":"institution","name":"Keio University Hospital","route":"/institutions/keio-university-hospital/"},{"id":"sso","kind":"institution","name":"Society of Surgical Oncology","route":"/institutions/sso/"}],"person":[{"id":"dcruz-anil","kind":"person","name":"Anil K. D'Cruz","route":"/people/dcruz-anil/"},{"id":"armando-giuliano","kind":"person","name":"Armando E. Giuliano","route":"/people/armando-giuliano/"},{"id":"elizabeth-mittendorf","kind":"person","name":"Elizabeth A. Mittendorf","route":"/people/elizabeth-mittendorf/"},{"id":"mark-faries","kind":"person","name":"Mark B. Faries","route":"/people/mark-faries/"},{"id":"monica-morrow","kind":"person","name":"Monica Morrow","route":"/people/monica-morrow/"},{"id":"paolo-veronesi","kind":"person","name":"Paolo Veronesi","route":"/people/paolo-veronesi/"}],"bottleneck":[{"id":"b-metastasis-biology","kind":"bottleneck","name":"Metastasis is understood least and studied last","route":"/bottlenecks/b-metastasis-biology/"},{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/"}],"idea":[{"id":"idea-fund-surgical-trials-network","kind":"idea","name":"A permanently funded international network for randomised cancer surgery trials","route":"/ideas/idea-fund-surgical-trials-network/"},{"id":"idea-fund-omission-deescalation-trials","kind":"idea","name":"Payer-funded trials that omit surgery or radiotherapy in low-risk patients","route":"/ideas/idea-fund-omission-deescalation-trials/"},{"id":"idea-fund-technique-innovation-prize","kind":"idea","name":"Prizes for unpatentable surgical and radiotherapy techniques proven in trials","route":"/ideas/idea-fund-technique-innovation-prize/"},{"id":"idea-bio2-lymph-node-immune-priming","kind":"idea","name":"Treat the draining lymph node before removing it","route":"/ideas/idea-bio2-lymph-node-immune-priming/"}],"technology":[{"id":"lymphoedema-decongestive-therapy","kind":"technology","name":"Compression, decongestive therapy and exercise for lymphoedema","route":"/technologies/lymphoedema-decongestive-therapy/"},{"id":"gamma-probes-dose-calibrators","kind":"technology","name":"Gamma probes, handheld gamma cameras and dose calibrators","route":"/technologies/gamma-probes-dose-calibrators/"},{"id":"intraoperative-fluorescence-imaging-systems","kind":"technology","name":"Intraoperative fluorescence and Cerenkov imaging systems (SPY, Firefly, LumiSystem, LightPath)","route":"/technologies/intraoperative-fluorescence-imaging-systems/"},{"id":"lymphoedema-surgery-and-early-detection","kind":"technology","name":"Lymphoedema: catching it early, and the operations for it","route":"/technologies/lymphoedema-surgery-and-early-detection/"},{"id":"spect-ct","kind":"technology","name":"SPECT/CT","route":"/technologies/spect-ct/"},{"id":"surgical-robot-platforms","kind":"technology","name":"Surgical robots: da Vinci, Hugo, Versius and single-port systems","route":"/technologies/surgical-robot-platforms/"}],"paper":[{"id":"paper-dcruz-elective-neck-dissection-nejm-2015","kind":"paper","name":"Elective versus therapeutic neck dissection in node-negative oral cancer","route":"/key-papers/paper-dcruz-elective-neck-dissection-nejm-2015/"}],"roadmap":[{"id":"surgery-roadmap","kind":"roadmap","name":"Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work","route":"/roadmaps/surgery-roadmap/"}],"company":[{"id":"alliance-oncology","kind":"company","name":"Alliance for Clinical Trials in Oncology","route":"/companies/alliance-oncology/"},{"id":"lightpoint-medical","kind":"company","name":"Lightpoint Medical","route":"/companies/lightpoint-medical/"},{"id":"mammotome","kind":"company","name":"Mammotome (Danaher)","route":"/companies/mammotome/"},{"id":"nsabp-foundation","kind":"company","name":"NSABP Foundation","route":"/companies/nsabp-foundation/"}]}}