***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE The aim of this study was to describe a minimally invasive technique enabling us to identify the sentinel lymph node in patients affected by early stage cervical cancer and to report the preliminary data . METHOD Patent Blue Violet was injected around the tumor . Laparoscopy was undertaken and the blue-dyed lymph nodes ( BDLN ) were sought . The evidence d BDLN were removed , and then the systematic dissection was carried out . Material . Thirty-five patients were su bmi tted to surgery . A systematic dissection was performed on 69 pelvic sidewalls ( no dissection was performed on the second side of the patient for whom we decided to renounce surgery after assessment of the first side ) . RESULTS One or more BDLN was evidence d in 59 of 69 dissections . The rate of failure depends on the quantity of injected blue dye . Failure to identify a BDLN depended on the quantity of injected blue dye : 3 of 6 ( 50 % ) for 1.5 ml or less , 3 of 18 ( 17 % ) for 2 ml , and only 4 of 45 ( 10 % ) after injection of 4 ml ( P = 0.05 ) . Among the 63 BDLN ( in 4 cases 2 BDLN were identified ) , 53 were located in contact with the external iliac vein , lateral to the inferior vesical artery , and ventral to the origin of the uterine artery , 7 were located close to the origin of one of the collaterals of the internal iliac artery , and 3 were adjacent to the left common iliac vein . One or more positive pelvic lymph nodes was found in 11 pelvic wall dissections done on 8 patients . The BDLN was the positive node or one of them in all cases . CONCLUSION If the sensitivity of the assessment of the BDLN is confirmed to be 100 % , this laparoscopic approach could transform the management of early cervical cancer PURPOSE To investigate the safety and clinical utility of the sentinel node procedure in early-stage vulvar cancer patients . PATIENTS AND METHODS A multicenter observational study on sentinel node detection using radioactive tracer and blue dye was performed in patients with T1/2 ( < 4 cm ) squamous cell cancer of the vulva . When the sentinel node was found to be negative at pathologic ultrastaging , inguinofemoral lymphadenectomy was omitted , and the patient was observed with follow-up for 2 years at intervals of every 2 months . Stopping rules were defined for the occurrence of groin recurrences . RESULTS From March 2000 until June 2006 , a sentinel node procedure was performed in 623 groins of 403 assessable patients . In 259 patients with unifocal vulvar disease and a negative sentinel node ( median follow-up time , 35 months ) , six groin recurrences were diagnosed ( 2.3 % ; 95 % CI , 0.6 % to 5 % ) , and 3-year survival rate was 97 % ( 95 % CI , 91 % to 99 % ) . Short-term morbidity was decreased in patients after sentinel node dissection only when compared with patients with a positive sentinel node who underwent inguinofemoral lymphadenectomy ( wound breakdown in groin : 11.7 % v 34.0 % , respectively ; P < .0001 ; and cellulitis : 4.5 % v 21.3 % , respectively ; P < .0001 ) . Long-term morbidity also was less frequently observed after removal of only the sentinel node compared with sentinel node removal and inguinofemoral lymphadenectomy ( recurrent erysipelas : 0.4 % v 16.2 % , respectively ; P < .0001 ; and lymphedema of the legs : 1.9 % v 25.2 % , respectively ; P < .0001 ) . CONCLUSION In early-stage vulvar cancer patients with a negative sentinel node , the groin recurrence rate is low , survival is excellent , and treatment-related morbidity is minimal . We suggest that sentinel node dissection , performed by a quality -controlled multidisciplinary team , should be part of the st and ard treatment in selected patients with early-stage vulvar cancer OBJECTIVE To evaluate the multicenter application of intraoperative lymphatic mapping , sentinel lymphadenectomy , and selective complete lymph node dissection ( LM/SL/SCLND ) for the management of early-stage melanoma . SUMMARY BACKGROUND DATA The multidisciplinary technique of LM/SL/SCLND has been widely adopted , but not vali date d in a multicenter trial . The authors began the international Multicenter Selective Lymphadenectomy Trial ( MSLT ) 5 years ago to evaluate the survival of patients with early-stage primary melanoma after wide excision alone versus wide excision plus LM/SL/SCLND .  This study examined the accuracy of LM/SL/SCLND in the MSLT , using the experience of the organizing center ( John Wayne Cancer Institute [ JWCI ] ) as a st and ard for comparison . METHODS Before entering patients into the r and omization phase , each center in the MSLT was required to finish a 30-case learning phase with complete nuclear medicine , pathology , and surgical review . Selection of  MSLT patients in the LM/SL/SCLND treatment arm was based on complete pathologic and surgical data . The comparison group of JWCI patients was selected using these criteria : primary cutaneous melanoma having a thickness > or = 1 mm with a Clark level > or = III , or a thickness < 1 mm with a Clark level > or = IV ( MSLT criterion ) ; LM/SL performed between June 1 , 1985 , and December 30 , 1998 ; and patient not entered in the MSLT . The accuracy of LM/SL/SCLND was determined by comparing the rates of sentinel node ( SN ) identification and the incidence of SN metastases in the MSLT and JWCI groups . RESULTS There were 551 patients in the MSLT group and 584 patients in the JWCI group . In both groups , LM performed with blue dye plus a radiocolloid was more successful ( 99.1 % ) than LM performed with blue dye alone ( 95.2 % ) ( p = 0.014 ) . After a center had completed the 30-case learning phase , the success of SN identification in the MSLT group was independent of the center 's case volume or experience in the MSLT . CONCLUSIONS Lymphatic mapping and sentinel lymphadenectomy can be successfully learned and applied in a st and ardized fashion with high accuracy by centers worldwide . Successful SN identification rates of 97 % can be achieved , and the incidence of nodal metastases approaches that of the organizing center . A multidisciplinary approach ( surgery , nuclear medicine , and pathology ) and a learning phase of > or = 30 consecutive cases per center are sufficient for mastery of LM/SL in cutaneous melanoma . Lymphatic mapping performed using blue dye plus radiocolloid is superior to LM using blue dye alone OBJECTIVE Intraoperative lymphatic mapping and sentinel lymph node identification ( SLN ) have been increasingly evaluated in the treatment of a variety of solid tumors , particularly breast cancer and melanoma . We sought to evaluate the feasibility of these procedures in patients undergoing radical hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer . METHODS Twenty patients with normal-appearing lymph nodes underwent intracervical injection of isosulfan blue dye ( lymphazurin 1 % ) at the time of planned radical hysterectomy and bilateral pelvic/low paraortic lymphadenectomy ( 40 nodal basins ) . Regional lymphatic tissue was inspected for dye uptake into lymphatic channels and lymph nodes . Tumor characteristics , surgical findings , and specific locations of lymphatic dye uptake were recorded and correlated with final pathology results . RESULTS Sentinel lymph nodes were identified in 12 of 20 ( 60 % ) patients . A total of 23 sentinel nodes were identified in 17 of 40 ( 43 % ) nodal basins dissected ( range : 0 - 2 per basin ) . Successful SLN identification was less likely in patients with tumors > 4 cm compared with those with tumors < /=4 cm ( P = 0.035 ) . Of 4 patients with metastatic nodal disease , 3 had tumor involving a SLN ; the fourth had no identifiable SLN ( inadequate study ) . In all , 3 of 8 lymph nodes with confirmed metastatic disease were identified using this technique . CONCLUSION SLN identification and intraoperative lymphatic mapping are feasible and safe . Lymphatic dye uptake appears to be less reliable in patients with larger tumors . Although sentinel node pathology was representative of the lymphatic basin sample d in all cases , the rate of SLN identification was low with this technique . Lymphatic mapping procedures should be further investigated in the treatment of early cervix cancer OBJECTIVES The aim of this study was to compare peri-operative morbidity and recurrence-free survival of early-stage cervical cancer patients treated by laparoscopic-assisted radical vaginal hysterectomy ( LARVH ) with time-matched radical abdominal hysterectomy ( RAH ) controls at our center . METHODS Since July 1984 , all patients with FIGO stage IA/IB cervical cancer undergoing radical surgery by members of our division have been entered into a prospect i ve data base . Since November 1996 , one surgeon at our center has performed LARVH on all surgically appropriate patients . Non-parametric tests were used . Differences between medians were compared using Wilcoxon Rank Sum test . Statistical analysis used the Kaplan-Meier method to calculate disease-free survival . Differences between survival curves were compared with the log rank test . Statistical significance was defined as P < 0.05 . RESULTS Between November 1996 and December 2003 , 71 and 205 patients have undergone LARVH and RAH , respectively , for FIGO stage IA/IB carcinoma of the cervix . Both groups were similar with respect to age and Quetelet index . There were no differences in tumor size , histology , grade , depth of invasion , lymph node metastases , or surgical margins . All laparoscopic procedures were completed successfully with no conversions to laparotomy . Intra-operative morbidity characteristics analyzed ( LARVH vs. RAH ) were blood loss 300 ml vs. 500 ml ( P < 0.001 ) , operative time 3.5 h vs. 2.5 h ( P < 0.001 ) , and intra-operative complications 13 % vs. 4 % ( P < 0.03 ) . Intra-operative complications in the LARVH group included : cystotomy ( 7 ) , ureteric injury ( 1 ) , and bowel injury ( 1 ) . There was no difference in transfusion rates . There was no difference between post-operative infectious and non-infectious complications ( LARVH vs. RAH ) , 9 % vs. 5 % and 5 % vs. 2 % , respectively . The median time to normal urine residual was 10 days vs. 5 days ( P < 0.001 ) , and the median length of hospital stay was 1 day vs. 5 days ( P < 0.001 ) . Twenty-two percent of patients received post-operative radiotherapy for high-risk features in both groups . After a median follow-up of 17 and 21 months , there have been 4 recurrences in the LARVH group and 13 in the RAH ( P = NS ) . The overall 2-year recurrence-free survival was 94 % and 94 % in the LARVH and RAH groups , respectively ( P = NS ) . CONCLUSION Our data demonstrate that early cervical cancer can be treated successfully with LARVH with similar efficacy and recurrence rates to RAH . The major benefits are less intra-operative blood loss and shorter hospital stay . It is a safe procedure with low overall morbidity and complication rates . However , at present , LARVH is associated with an increase in intra-operative complications , and patients may have an increased time to return to normal bladder function BACKGROUND The goals of axillary-lymph-node dissection ( ALND ) are to maximise survival , provide regional control , and stage the patient . However , this technique has substantial side-effects . The purpose of the B-32 trial is to establish whether sentinel-lymph-node ( SLN ) resection can achieve the same therapeutic goals as conventional ALND but with decreased side-effects . The aim of this paper is to report the technical success and accuracy of SLN resection plus ALND versus SLN resection alone . METHODS 5611 women with invasive breast cancer were r and omly assigned to receive either SLN resection followed by immediate conventional ALND ( n=2807 ; group 1 ) or SLN resection without ALND if SLNs were negative on intraoperative cytology and histological examination ( n=2804 ; group 2 ) in the B-32 trial . Patients in group 2 underwent ALND if no SLNs were identified or if one or more SLNs were positive on intraoperative cytology or subsequent histological examination . Primary endpoints , including survival , regional control , and morbidity , will be reported later . Secondary endpoints are accuracy and technical success and are reported here . This trial is registered with the Clinical Trial registry , number NCT00003830 . FINDINGS Data for technical success were available for 5536 of 5611 patients ; 75 decl 
    Output:
    
The results of this study highlight how the success of SLN detection depends on technique , individual surgeon experience , and the patient population chosen for this procedure .
This multicenter study is a good example of how excellent results may be diluted if stringent criteria are not widely applied to a general population .
Without stringent quality control measures , the overall sensitivity of the procedure can be significantly reduced .
On average , that is less than five patients per year per center and potentially even less per surgeon .
The main theoretical benefit of the SLN procedure is to reduce the requirement for a complete lymphadenectomy with its associated morbidity in a patient population at low risk for lymph node metastases .
In early-stage cervical cancer , the incidence of pelvic lymph node metastasis is approximately 10 % ; therefore , if the SLN is negative , 90 % of patients can avoid a full pelvic lymphadenectomy and the associated morbidity of blood loss , neural injury , lymphocyst , and lymphedema .
It is unclear whether more advanced cancers can obtain the same benefit and whether the SLN concept is valid in such patients .