[The detection of sentinel lymph node in nuclear medicine]

The isotopic detection of the sentinel node is undergoing a fast development in breast cancer and melanoma. It requires a good collaboration between a surgeon and a nuclear medicine specialist. Although the method is now well defined for melanoma, several options remain possible for breast cancer. The injected dose and volume can differ between centers, as well as the sites of injection in terms of their number, anatomical location and depth. However, since all options seem to provide equivalent results, a single intradermal periareolar injection could be the preferred choice. The role of imaging remains controversial, but it provides a definite complementary information, in particular in case of an unusual location of the sentinel node. The addition of dye injection also adds to the results. The optimal use of a peroperative hand-held gamma probe requires some training for the surgeon. A good selection of the indications is essential for a successful detection. Other fields of application are under investigation such as colon cancer, head and neck tumors, lung and prostate cancers. By avoiding a majority of the routine axillary lymph nodes dissections in small breast cancer, the isotopic detection of the sentinel node should dramatically decrease the morbidity of axillary staging and the duration of hospital stay for the patients.