Sentinel lymph node biopsy (SLNB) is still the standard of care for axillary nodal staging in patients with invasive breast cancer (BC) and clinically negative lymph nodes (LNs). It successfully replaced the more invasive and morbid axillary lymph node dissection (ALND). The actual standard for SLNB is the radioisotope (RI) with or without blue dye (BD) technique. Because of several drawbacks reported in worldwide experiences, new techniques have been developed in the last years: indocyanine green (ICG) fluorescence, superparamagnetic iron oxide (SPIO) nanoparticles and contrast-enhanced ultrasound (CEUS) using microbubbles. Whilst each technique has its own advantages/disadvantages they are increasing their efficacy and are candidate to represent a new standard for SLNB in next future. This is a comprehensive review of current limitations of conventional techniques besides the improvements and innovations of new methods which, anyway, need future randomized controlled trials to be fully validated.

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BackgroundPenile cancer is a relatively uncommon cancer in developed nations. Metastatic disease is rare, but lymphatic or vascular spreading has been previously reported to the liver, lungs, bones, brain, heart and skin.Case presentationWe report a case of a 49-year-old white man with a penile squamous cell carcinoma previously treated with partial penectomy and bilateral inguinal lymph node dissection, followed by adjuvant therapy. Three years after treatment, the primitive neoplasm metastasized to the breast, presenting as a painful lump. Differentials of a secondary versus a malignant primary tumor were considered and in view of a diagnostic dilemma the lesion was excised.ConclusionsThis case is unusual in its site of metastatic progression as well as in its pattern of clinical presentation. Awareness of such a condition by physicians is mandatory in order to make an early diagnosis and start prompt and correct therapeutic planning.