Gastroentérologie Clinique et Biologique (2009) 33, 446—450 VIEW POINT Sentinel lymph node biopsy in anal cancer: A review Biopsie du ganglion sentinelle dans le cancer anal M. Mistrangelo * , M. Morino Department of Surgery, Centre of Minimal Invasive Surgery, Molinette Hospital, University of Turin, Cso A.M. Dogliotti 14, 10126 Turin, Italy Available online 4 March 2009 Introduction Anal cancer is a rare disease. An estimated 5070 new cases (2020 men and 3050 women) of anal cancer (involving the anus, the anal canal, or the anorectum) occurred in the United States in 2007, accounting for approximately 1.85% of digestive system cancers. It has been estimated that 680 deaths due to anal cancer occurred in the US alone in 2007 [1]. Published data suggest that its incidence is rising and that the risk factors for anal cancer include human papilloma virus (HPV) infection, cervical dysplasia or cancer, human immunodeficiency virus (HIV) seropos- itivity, low CD4 count, cigarette smoking, anoreceptive intercourse, and immunosuppression following solid organ transplant [2]. Since 1974, the management of epidermoid carcinoma of the anal canal has changed from abdominoperineal resection to a combination of radiation and chemotherapy [3]. This approach allows sphincter preservation in most patients and achieves high rates of survival: the reported overall five-year survival rate with combined treatment is 58—92% [4]. ∗ Corresponding author. E-mail addresses: mistrangelo@katamail.com, mmistrangelo3@molinette.piemonte.it (M. Mistrangelo). Approximately 12% of patients will eventually develop distant metastases, most commonly in the liver and the lung [5], while lymph node metastases occur in 10—25%. The presence of inguinal lymph node metastases in anal cancer reduces overall survival to 30—58% [6]. In general, lym- phatic drainage occurs through passive processes (osmotic and hydrostatic pressure) and active muscular contraction that cause centripetal lymph flow. Neoplastic lymph flow in the anal region is bidirectional: proximal to the den- tate line, two-thirds of the lymph fluid is drained along the inferior rectal artery to the origin of the inferior mesen- teric artery; while distal to the dentate line the main pathway is to the inguinal lymph nodes along the femoral artery [6]. Although the standard treatment for anal cancer is defined, the ideal approach to inguinal lymph nodes remains debated. The true incidence of inguinal node involvement is difficult to determine; clinical examination and radiological imaging each has a sensitivity of 50% [7]. Since 2001 [8] sen- tinel lymph node (SLN) biopsy in patients with anal cancer has improved the accuracy of inguinal staging and planning for radiotherapy, preventing the need for inguinal radiother- apy and eliminating its related morbidity in patients without metastasis at SLN biopsy. The literature has described 161 patients who have undergone this technique to date. This study presents our experience and a review of the published data to assess the feasibility of SLN biopsy in anal 0399-8320/$ – see front matter © 2009 Elsevier Masson SAS. All rights reserved. doi:10.1016/j.gcb.2009.01.009