Lymphoscintigraphy and lymphatic mapping for identification of sentinel lymph nodes

The recently introduced technique of sentinel lymph node dissection (SLND) may replate complete axillary lymph node dissection for axillary staging of early breast cancer. Successful SLND is predicated on meticulous delineati on of the lymphatic pathway and sentinel node(s). Currently employed lympha tic mapping materials include vital blue dyes and radioactive tracers. Tech niques of intraoperative lymphatic mapping and SLND using dye, tracer, or b oth have high success rates in the hands of experienced investigators, but their routine and widespread use awaits resolution of questions about the t iming, dose, and type of radioactive tracer; the optimal lymphatic mapping technique; indications and contraindications for SLND; and certification of qualified surgeons, pathologists, and nuclear medicine physicians.