The added value of SPECT-CT for the identification of sentinel lymph nodes in early stage oral cancer

Abstract

PurposeTo assess the role of single-photon emission computed tomography with computed tomography (SPECT-CT) for the identification of sentinel lymph nodes (SLNs) in patients with early stage (T1–T2) oral cancer and a clinically negative neck (cN0).MethodsIn addition to planar lymphoscintigraphy, SPECT-CT was performed in 66 consecutive patients with early stage oral cancer and a clinically negative neck. The addition of SPECT-CT to planar images was retrospectively analyzed for the number of additional SLNs, more precise localization of SLNs, and importance of anatomical information by a team consisting of a nuclear physician, surgeon, and investigator.ResultsIdentification rate for both imaging modalities combined was 98% (65/66). SPECT-CT identified 15 additional SLNs in 14 patients (22%). In 2/15 (13%) of these additional SLNs, the only metastasis was found, resulting in an upstaging rate of 3% (2/65). In 20% of the patients with at least one positive SLN, the only positive SLN was detected due to the addition of SPECT-CT. SPECT-CT was considered to add important anatomical information in two patients (3%). In 5/65 (8%) of the patients initially scored SLNs on planar lymphoscintigrams were scored as non-SLNs when SPECT-CT was added. There were four false-negative SLN biopsy procedures in this cohort.ConclusionsThe addition of SPECT-CT to planar lymphoscintigraphy is recommended for the identification of more (positive) SLNs and better topographical orientation for surgery in sentinel lymph node biopsy for early stage oral cancer.

CT lymphography for sentinel lymph node mapping of clinically N0 early oral cancer

“…Therefore, additional imaging methods are required to detect this form of metastasis. Preoperative SLN mapping of N0 early oral cancer has commonly been performed using lymphoscintigraphy and/or SPECT/CT, with a reported identification rate of 95 to 100% [9, 11–13]. Nevertheless, SLN mapping using RI may be difficult for detecting these lingual lymph nodes because of their proximity to the primary tumor [31].…”

Feasibility of intraoperative detection of sentinel lymph nodes with 89-zirconium-labelled nanocolloidal albumin PET-CT and a handheld high-energy gamma probe

“…The high-energy photon probe detected 10 of 13 SLNs as identified by PET/CT lymphoscintigraphy. Although the conventional use of 99m Tc-nanocolloidal albumin and SPECT/CT may result in the detection of additional SLN compared to gamma camera imaging, detection of level I lymph nodes in floor-of-mouth tumours remains challenging [ 12 ]. As demonstrated previously [ 8 ], PET/CT using 89 Zr-nanocolloidal albumin was able to identify a SLN near the injection site.…”

Sentinel-Lymphknoten-Diagnostik im Kopf/Halsbereich: Indikation und aktuelle Untersuchungsprotokolle

“…Der Nutzen der SPECT/CT wird derzeit z. T. noch kontrovers diskutiert [17,20], wobei die meisten Autoren den Nutzen der Methode herausstellen [8,13,14,18,27,28,29,31]. Auch die EANM guidelines [4,16] empfehlen, unbedingt eine SPECT/CT der Kopf-Hals-Region durchzuführen, wenn diese Technik verfügbar ist.…”