Lymphatic mapping with SPECT‐CT for evaluation of contralateral drainage in lateralized oropharyngeal cancers using an awake injection technique

Thomas, Carissa M.; Khan, Muhammad Zia; Mohan, Ravi; Hendler, Aaron; Hosni, Ali; Chepeha, Douglas B.; Goldstein, David P.; Cooper, Richard M.; Almeida, John R. de

doi:10.1002/hed.26011

Cited by 8 publications

(4 citation statements)

References 35 publications

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“…We observed that in the five patients with N+ disease, the [ 99m Tc]Tc-nanocolloid bypassed the pathologically enlarged nodes and accumulated in the neighboring echelon nodes or at the contralateral side, confirming the results of a recent study. 14 Metastasis formation in lymph nodes prevents tracer accumulation with subsequent drainage and accumulation in the next echelons. 15 This supports the notion that the drainage of the colloid tracer mimics the lymphogenic metastatic route of tumor cells.…”

Section: Discussionmentioning

confidence: 99%

Sentinel node identification in laryngeal and pharyngeal carcinoma after flexible endoscopy‐guided tracer injection under topical anesthesia: A feasibility study

et al. 2023

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Background: The aim of this study was to investigate the feasibility of flexible endoscopy-guided tracer injection for sentinel lymph node (SLN) identification in patients with laryngeal and pharyngeal carcinoma. Methods: Sixteen cT1-4N0-2M0 patients with laryngeal or pharyngeal carcinoma underwent intra-and peritumoral [ 99m Tc]Tc-nanocolloid injections after topical anesthesia under endoscopic guidance. SPECT-CT scans were performed at two time points.Results: Tracer injection and visualization of SLNs was successful in 15/16 (94%) patients. Median number of tracer injections was 1 intratumoral and 3 peritumoral. The median duration of the endoscopic procedure including tracer injection after biopsy taking was 7 min (range 4-16 min). A total of 28 SLNs were identified which were all visualized on the early and late SPECT-CT. Most SLNs were visualized in neck levels II and III. Conclusions: Flexible endoscopy-guided tracer injection for SLN identification is a feasible and fast procedure in laryngeal and pharyngeal carcinoma patients.

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Section: Discussionmentioning

confidence: 99%

Sentinel node identification in laryngeal and pharyngeal carcinoma after flexible endoscopy‐guided tracer injection under topical anesthesia: A feasibility study

et al. 2023

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“…Here we demonstrate the feasibility of using lymphatic mapping with SPECT-CT to select patients for unilateral neck treatment. Our group has previously reported the feasibility of using this imaging modality to identify lymphatic drainage patterns, and now we demonstrate that treatment of the contralateral neck informed by lymphatic mapping provides acceptable early disease control in the contralateral neck and identifies patients at risk for contralateral nodal drainage [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…A detailed description of the injection technique was previously described by our group in an initial feasibly study [ 10 ]. All radiotracer injections were performed awake in the Nuclear Medicine Suite.…”

Section: Methodsmentioning

confidence: 99%

“…Pre-operative lymphatic mapping is a well-tolerated, minimally invasive procedure that can be performed on awake patients. This method is a reliable tool, characterizing lymphatic spread in 90% of tumors [ 10 ]. Identifying tumor-specific lymphatic drainage patterns allows for tailored treatments to nodal basins at greatest risk for regional disease spread.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating contralateral neck failure in patients with lateralized OPSCC treated with transoral robotic surgery and neck management based on pre-operative SPECT-CT lymphatic mapping

Berania

Hosni

Thomas

et al. 2022

Journal of Otolaryngology - Head & Neck Surgery

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Background Risk of contralateral nodal metastases in oropharyngeal squamous cell carcinoma (OPSCC) is relatively low, however, many OPSCC patients receive bilateral neck treatment. This study evaluates the oncological outcomes with management of the contralateral cN0 neck based on lymphatic mapping with single photon emission computed tomography (SPECT-CT). Methods Retrospective evaluation of patients with lateralized cT1-2 and contralateral cN0 OPSCC treated with primary surgery between December 2017 and October 2019. All patients underwent pre-operative lymphatic mapping using SPECT-CT. Clinical parameters including demographics, tumor characteristics and oncological outcomes were recorded. Results Thirteen patients underwent primary site resection with transoral robotic surgery (TORS) and ipsilateral neck dissection with or without adjuvant therapy. Twelve patients (92.3%) had ipsilateral drainage on SPECT-CT, whereas 1 (7.7%) patient had bilateral neck lymphatic drainage. Four patients (30.8%) underwent post-operative radiation therapy (PORT). Three patients with unilateral drainage on SPECT-CT underwent PORT with unilateral neck irradiation, and 1 patient with bilateral drainage underwent PORT with bilateral neck irradiation. Seven (53.8%) patients were staged as pT1, 6 (46.2%) patients as pT2, 6 (46.2%) patients were pN0, 3 (23.1%) patients were pN1, 1 (7.7%) patient was pN2a for and 3 (23.1%) patients were N2b. The median distance of the tumor from midline was 1.05 cm (0.0–1.58). Primary sites included tonsil (n = 10, 76.9%) and tongue base (n = 3, 23.1%). The median follow-up time was 15.4 months. All patients were disease free at the latest follow-up with no contralateral neck failures. Conclusions Pre-operative mapping of lymphatic drainage in early stage OPSCC with SPECT-CT is a promising tool which can reduce treatment to the contralateral neck potentially without compromising oncological outcomes. Graphical Abstract

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A multi‐institutional feasibility lead‐in trial of lymphatic mapping with SPECT–CT for evaluating contralateral disease in lateralized oropharynx cancer using 99m‐technetium sulfur colloid

Sarkis,

Yao,

Hendler

et al. 2024

Head & Neck

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BackgroundLymphatic mapping with SPECT–CT has been demonstrated to accurately define lymphatic drainage patterns in oropharyngeal cancer but there has yet to be a study demonstrating its feasibility across multiple institutions.MethodsTwelve adult patients with lateralized oropharyngeal carcinoma (T1‐T3) who were planned for definitive or adjuvant radiotherapy without contralateral nodal disease underwent injection of 99‐m technetium sulfur colloid followed by static planar lymphoscintigraphy to verify tracer migration, and SPECT–CT acquired at 30 ± 15 min (optional) and 3 h (±1 h) (mandatory time‐point).ResultsAll 12 patients completed the study with 7/12 patients having the injections performed under local anesthetic and 5 patients requiring general anesthetic. There were no tracer migration failures and there were no serious adverse events or complications encountered. Four out of 12 patients (33%) showed contralateral drainage patterns.ConclusionsLymphatic mapping with SPECT–CT of lateralized oropharyngeal squamous cell carcinoma can be performed safely across multiple institutions.

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Lymphatic mapping with SPECT‐CT for evaluation of contralateral drainage in lateralized oropharyngeal cancers using an awake injection technique

Cited by 8 publications

References 35 publications

Sentinel node identification in laryngeal and pharyngeal carcinoma after flexible endoscopy‐guided tracer injection under topical anesthesia: A feasibility study

Sentinel node identification in laryngeal and pharyngeal carcinoma after flexible endoscopy‐guided tracer injection under topical anesthesia: A feasibility study

Evaluating contralateral neck failure in patients with lateralized OPSCC treated with transoral robotic surgery and neck management based on pre-operative SPECT-CT lymphatic mapping

A multi‐institutional feasibility lead‐in trial of lymphatic mapping with SPECT–CT for evaluating contralateral disease in lateralized oropharynx cancer using 99m‐technetium sulfur colloid

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