Lymphoscintigraphy and radioguided sentinel node biopsy in oral cavity squamous cell carcinoma: same day protocol

Abstract

The routine use of a sentinel node biopsy (SNB) protocol in oral cavity squamous cell carcinomas (SCC) has been challenged on the basis of the elevated number of sentinel nodes (SNs) detected (>2.5) and on the multiply neck level involvement reported in several studies. These data limit the practical application of the protocol, because in such cases, it seems easier and safer to perform a selective neck dissection. The aim of our study is to perform radioguided surgery 1-3 h after lymphoscintigraphy (same day protocol) to detect the lymph nodes closest to the tumour site. In our study, 12 patients affected by cT1-2 N0 SCC of the oral cavity were submitted to a same day protocol of a lymphoscintigraphic examination (1-3 h before surgery) and a radioguided SNB. We used a hand-held gamma probe and performed an elective neck dissection on all patients. The SNs were found in all cases with 83% localised in the ipsilateral neck in only levels I-II. The mean number of SN detected was 2.1, with a mean pathological size of 13.8 mm measured on pathological specimen. Metastases were found in 5/12 cases (41.6%), on levels I, II and III and all were identified by step serial sectioning and routine H&E staining. This study confirms the accuracy of SNB in predicting the presence of occult metastases. This protocol is designed to detect SNs, which are almost always on neck level I and II, thereby limiting the number of nodes examined and the extension of the surgical approach.

Platinum concentration in sentinel lymph nodes after preoperative intra-arterial cisplatin chemotherapy targeting primary tongue cancer

“…Even in patients with no clinical evidence of lymph node metastasis, there is a high incidence of occult metastasis, which ranges from 10 to 50 % depending on the primary tumor characteristics including tumor subsite, T stage and depth of invasion [10][11][12][13][14]. Additional treatment is not always successful in cases where subclinical nodal metastasis emerges clinically after initial treatment.…”

Sentinel Node in Oral Cancer

“…35 Fused SPECT/CT imaging may allow more accurate anatomical localization of the SNs adjacent to the primary lesion (Fig. 4).…”

Intraoperative sentinel node imaging versus SPECT/CT in oral cancer – A blinded comparison

“…The complex nature of lymphatic drainage within the head and neck means that intraoperative identification of sentinel nodes (SNs) is always informed by preoperative imaging, traditionally lymphoscintigraphy (LSG) and/or Single Photon Emission Computed Tomography (SPECT)/CT) [1][2][3][4]. These imaging modalities are outpatient based, with radiotracer injection up 24 hours prior to surgery [1,5]. Results of multiple sentinel node biopsy (SNB) studies have shown promising results in early oral cancer with large studies reporting overall sensitivity 88-97% in detection of occult neck metastasis [2,3,6,7].…”