Concluding Remarks

Lymphatic mapping with selective lymph node biopsy has created a renewed interest in lymphoscintigraphy. This development increases our knowledge of the anatomy and physiology of the lymphatic system. Old dogmas continue to be modified. The result is a better understanding of the process of lymphatic dissemination. Lymphoscintigraphy is a crucial link in lymphatic mapping with selective lymphadenectomy. It is an elegant and simple diagnostic technique that can readily be performed in any nuclear medicine department. Lymphoscintigraphy is well tolerated by patients. A number of satisfactory tracers are available for this procedure. Combined dynamic and static imaging with attention to detail yields high-quality images that provide important information. With this technique, the nuclear medicine physician provides a road map that guides the surgeon to the sentinel node. Lymphoscintigraphy flawlessly identifies all basins at risk for metastatic disease. Unusual routes of drainage and sentinel nodes outside the generally recognized lymphatic basins are indicated. The location of a sentinel node can be marked on the skin. This aids the surgeon with the decision of where and in what direction to make the incision. Despite these strong points, the surgeon must be aware of the fact that the images do not necessarily always indicate the true number of sentinel nodes and that a sentinel node can be difficult to distinguish from secondary nodes. We nevertheless feel that lymphatic mapping cannot be done in a responsible fashion without high-quality lymphoscintigraphy in every patient.

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