Does imaging in sentinel node scintigraphic localization add value to the procedure in patients with breast cancer?

Imaging sentinel nodes with pre-operative lymphoscintigraphy effectively assures successful sentinel node identification. However, sentinel nodes are still identified in the majority of image negative patients. Given the logistics and cost required to perform pre-operative lymphoscintigraphy its routine use may not be justified. It may be valuable for surgeons in the learning phase and in obese patients who have increased risk of intra-operative failed localization. A negative pre-operative lymphoscintiscan predicts inability to localize with the hand-held gamma probe. Patients with no 'hot node' on the lymphoscintiscan are more likely to have failed localization using the gamma probe only. Therefore, blue dye should be used along with the gamma probe to optimize the localization rate in these patients.