Intraoperative Radiolymphoscintigraphy for Detection of Occult Nodal Metastasis in Patients with Head and Neck Squamous Cell Carcinoma

Zitsch, Robert P.; Todd, Daniel W.; Renner, Gregory J.; Singh, Amolak

doi:10.1016/s0194-5998(00)70192-6

Cited by 72 publications

(29 citation statements)

References 18 publications

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“…With regard to this background SN detection proved to be an accurate technique in melanoma and breast cancer patients, in order to predict lymph node status (Ferwerda et al, 2000;Gennari et al, 2000;Veronesi et al, 2001). Corresponding to previously reported results in SN detection in easily accessible SCC of the upper aerodigestive tract like oral carcinoma (van den Brekel et al, 1999;Nieuwenhuis et al, 2000;Margolin et al, 2001;Zitsch et al, 2000), the SN concept may also be of significance in pharyngeal and laryngeal cancer, which so far have rarely been the topic of targeted investigations.…”

Section: Discussionsupporting

confidence: 53%

Sentinel node detection in N0 cancer of the pharynx and larynx

et al. 2002

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Neck lymph node status is the most important factor for prognosis in head and neck squamous cell carcinoma. Sentinel node detection reliably predicts the lymph node status in melanoma and breast cancer patients. This study evaluates the predictive value of sentinel node detection in 50 patients suffering from pharyngeal and laryngeal carcinomas with a N0 neck as assessed by ultrasound imaging. Following 99m-Technetium nanocolloid injection in the perimeter of the tumour intraoperative sentinel node detection was performed during lymph node dissection. Postoperatively the histological results of the sentinel nodes were compared with the excised neck dissection specimen. Identification of sentinel nodes was successful in all 50 patients with a sensitivity of 89%. In eight cases the sentinel node showed nodal disease (pN1). In 41 patients the sentinel node was tumour negative reflecting the correct neck lymph node status (pN0). We observed one false-negative result. In this case the sentinel node was free of tumour, whereas a neighbouring lymph node contained a lymph node metastasis (pN1). Although we have shown, that skipping of nodal basins can occur, this technique still reliably identifies the sentinel nodes of patients with squamous cell carcinoma of the pharynx and larynx. Future studies must show, if sentinel node detection is suitable to limit the extent of lymph node dissection in clinically N0 necks of patients suffering from pharyngeal and laryngeal squamous cell carcinoma. British Journal of Cancer (2002) Paralell to other tumour entities there were intensified efforts within the last two decades, which are still discussed controversially, to limit the extent of lymph node dissection in the clinically staged N0 situations also for head and neck cancer patients. The aim of reducing a potential excess of surgical therapy for the patient is currently achieved quite successfully in other tumour entities by applying the so-called sentinel node (SN) concept (Lingam et al, 1997;De Cicco et al, 2000;Lantzsch et al, 2001). The extensive investigations on large patient cohorts in breast cancer and malignant melanoma are opposed by a comparative paucity of experience with the SN concept for SCC of the upper aerodigestive tract (Pitman et al, 1998;Shoaib et al, 1999Shoaib et al, , 2001Alex et al, 2000;Chiesa et al, 2000;Colnot et al, 2001;Stoeckli et al, 2001). Most of these articles predominantely deal with oral cancer. Contrary to this, it was the aim of the present study to analyse the role of the SN procedure in patients with pharyngeal and laryngeal carcinoma, which are the most frequent cancers of the upper aerodigestive tract. Primary criterion for inclusion was the N0 neck as staged by ultrasound scanning. Further inclusion criterion was the feasibility of a transoral exposure of the tumour. Adequate injection of the tracer substance especially in the caudal margin of the tumour. Due to inadequate exposure of the tumour three patients (2x larynx, 1x hypopharynx) had to be excluded from the study. PATIENTS ...

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Section: Discussionsupporting

confidence: 53%

Sentinel node detection in N0 cancer of the pharynx and larynx

et al. 2002

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“…This technique has the potential to define those cN0 patients in whom neck dissection is most appropriate (i.e., those who are pathologically node positive), thereby obviating END and its associated morbidities in nodenegative patients. Numerous single-institution studies have suggested that SLN mapping in SCCHN accurately predicts the status of the neck (5,(17)(18)(19)(20)(21), and this finding is currently being evaluated in a large multicenter validation trial sponsored by the American College of Surgeons Oncology Group (ACOSOG Z0360 trial). When combined with intraoperative analysis of the SLN(s), this approach could allow for definitive staging and surgical treatment in a single procedure.…”

Section: Introductionmentioning

confidence: 99%

Molecular Staging of Cervical Lymph Nodes in Squamous Cell Carcinoma of the Head and Neck

Ferris

Raja³

et al. 2005

Cancer Research

100

119

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Clinical staging of cervical lymph nodes from patients with squamous cell carcinoma of the head and neck (SCCHN) has only 50% accuracy compared with definitive pathologic assessment. Consequently, both clinically positive and clinically negative patients frequently undergo neck dissections that may not be necessary. To address this potential overtreatment, sentinel lymph node (SLN) biopsy is currently being evaluated to provide better staging of the neck. However, to fully realize the potential improvement in patient care afforded by the SLN procedure, a rapid and accurate SLN analysis is necessary. We used quantitative reverse transcription--PCR (QRT-PCR) to screen 40 potential markers for their ability to detect SCCHN metastases to cervical lymph nodes. Seven markers were identified with good characteristics for identifying metastatic disease, and these were validated using a set of 26 primary tumors, 19 histologically positive lymph nodes, and 21 benign nodes from patients without cancer. Four markers discriminated between positive and benign nodes with accuracy > >97% but only one marker, pemphigus vulgaris antigen (PVA), discriminated with 100% accuracy in both the observed data and a statistical bootstrap analysis. A rapid QRT-PCR assay for PVA was then developed and incorporated into a prototype instrument capable of performing fully automated RNA isolation and QRT-PCR. The automated analysis with PVA provided perfect discrimination between histologically positive and benign lymph nodes and correctly identified two lymph nodes with micrometastatic tumor deposits. These assays were completed ( from tissue to result) in f f30 minutes, thus demonstrating the feasibility of intraoperative staging of SCCHN SLNs by QRT-PCR. (Cancer Res 2005; 65(6): 2147-56)

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“…Studies applying a radiolabelled tracer with or without additional blue dye, however, were promising. The majority of the studies reported results favouring the sentinel lymph-node concept (Koch et al, 1998;Shoaib et al, 1999Shoaib et al, , 2001Alex et al, 2000;Zitsch et al, 2000;Mozzillo et al, 2001;Stoeckli et al, 2001Stoeckli et al, , 2002Barzan et al, 2002;Werner et al, 2002a, b). Groups who worked with blue dye report of an extravasation of the blue dye into the tissue (Pitman et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

“…Alex et al (2000) suggested that an activity three times higher than the background should classify a sentinel lymph node. Zitsch et al (2000) adopted a definition used in malignant melanomas defining the sentinel node as having two times the background activity count rate. Werner et al (2002a) characterised sentinel lymph nodes as the three nodes with the highest activity emitting at least 10 times the background counts.…”

Section: Discussionmentioning

confidence: 99%

Sentinel lymph-node biopsy in head and neck cancer

et al. 2004

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The aim of the study was to assess the diagnostic value of the sentinel node method in patients suffering from squamous cell carcinoma of the upper aerodigestive tract. In 50 patients with oral, pharyngeal or laryngeal carcinomas staged N0 up to 50 MBq technetium-99m colloid were injected peritumorally. Sentinel nodes were localised using a g-probe in the setting of an elective neck dissection. Pathological findings of sentinel nodes and corresponding neck specimens were compared. In 46 patients sentinel nodes were detected. Of these 34 patients were free of metastatic disease in the sentinel nodes and in the neck specimens. In 12 patients clinically occult metastases were found in the sentinel nodes. Three metastases were detected only after additional sectioning of the sentinel nodes. In four patients, a sentinel lymph node could not be localised. Our results support the sentinel node concept in head and neck cancer and a definition of the sentinel nodes as the three nodes with the highest activity. Careful clinical staging of the neck and thorough pathological evaluation of the sentinel nodes are necessary to avoid false-negative results.

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Intraoperative Radiolymphoscintigraphy for Detection of Occult Nodal Metastasis in Patients with Head and Neck Squamous Cell Carcinoma

Abstract: Intraoperative radiolymphoscintigraphy appears to be a feasible and promising procedure to aid the surgeon in more accurately detecting occult metastatic HNSCC.

Cited by 72 publications

References 18 publications

Sentinel node detection in N0 cancer of the pharynx and larynx

Sentinel node detection in N0 cancer of the pharynx and larynx

Molecular Staging of Cervical Lymph Nodes in Squamous Cell Carcinoma of the Head and Neck

Sentinel lymph-node biopsy in head and neck cancer

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