Basic anatomical features of Cactaceae have been studied since the sixteenth century. This anatomical research has focused on selected features related to different external forms or on stem photosynthetic metabolism. Anatomical stem features, however, have rarely been taken into consideration in systematic studies. Recent work has focused on the subfamily Cactoideae because it is the largest and most diverse subfamily of Cactaceae. Molecular analyses support the monophyly of Cactoideae, but tribal and generic relationships are mostly unresolved. A major goal of this study was to synthesize the available information about anatomical stem features of Cactoideae and to evaluate their usefulness in phylogenetic analysis. Although dermal and vascular tissues have been studied for nearly 350 species of Cactoideae, comprehensive investigations are needed for most members of specific genera or tribes. Phylogenetic analysis based on structural data (morphology and anatomy) showed that the subfamily Cactoideae is monophyletic. This result supports molecular evidence and corroborates that highly reduced leaves are the synapomorphy of this clade. With the exception of Cacteae and Rhipsalideae, the tribes are not monophyletic. The morphological characters that have been used to define the tribes are not synapomorphies and have evolved independently in different lineages. Some anatomical features are unique characters that distinguish terminal taxa; for example, silica grains in dermal and hypodermal cells in Stenocereus, prismatic crystals in dermal and hypodermal cells of Neobuxbaumia, and lack of medullary bundles in members of Cacteae. Most anatomical features, however, behave in a highly homoplasious manner in the analysis of the subfamily. Other studies at the tribal or generic level show that anatomical features are informative and contribute to support different clades. Further studies of Cactoideae, at different taxonomic levels, that include anatomical features, are needed in order to understand their evolution.