Lymphatic mapping and sentinel node biopsy: a surgical perspective

Lymphatic mapping and sentinel node biopsy has been rapidly and widely adopted by the surgical community as an oncologic equivalent elective lymphadenectomy for regional node staging in both melanoma and breast cancer. Despite being the de facto standard of care, it remains a highly unstandardized procedure surrounded by many unresolved controversies for surgeons who perform the procedure. The controversies are as basic as the definition of the real sentinel node and as specific as the appropriate localization pharmaceutical(s), site of injection, timing of the injection, and utility of external scintigraphy (dynamic versus. static). Furthermore, questions regarding surgical training, indications, and contraindications remain unanswered. Because there are few long-term studies stratified by technique and indication, the resolution of these surgical controversies are unlikely in the near future.