Lymphoscintigraphy in Tumors of the Head and Neck Using a Double Tracer Technique

Abstract

Knowledge of possible lymphatic drainage may facilitate plan ning of surgery for patients with head and neck tumors. There fore, the aim of this study was to present a method of lymphoscintigraphy with special attention to an accurate correlation of lymphatic drainage to anatomic regions. Methods: Lymphoscin tigraphy was performed using a double tracer technique before surgery in a total of 75 patients with squamous cell carcinoma of the head and neck. All patients received 100 MBq 99mTc-colloidat three to four peritumoral sites. A perchlorate solution (2 ml) was given orally to block salivary glands and the thyroid gland. Patients received 50 MBq 99mTc-pertechnetateintravenously for body contouring 20 min postinjection. Planar images were obtained over 5 min each, at 30 min and 4 h postinjection from anterior, right lateral and left lateral views with a large-field-ofview gamma camera. Lymphatic drainage was assessed by visual inspection and assigned to six cervical compartments. Results: Neither the salivary glands nor the thyroid gland were seen in any of the patients. In 22 of 75 patients (29.3%), the injection site was the only focal tracer uptake seen. In contrast, lymphatic drainage was identified in the remaining 53 patients (70.7%), and lymph nodes could be assigned easily to the six cervical compartments. Of 75 patients, 36 (48%) exhibited ipsilateral lymphatic drainage. In addition, 17 patients (22.7%) with unilateral tumor showed bilateral (n = 12), contralateral (n = 2) or retropharyngeal (n = 3) lymphatic drainage. In 3 of these 17 patients, bilateral lymph node métastaseswere proven. A sub group of 12 patients (16%) exhibited N2c nodal status, despite a unilateral localized primary tumor. In 3 of these 12 patients, surgery was extended as a result of scintigraphic findings from unilateral toward bilateral neck dissection, and histology con firmed nodal involvement in these patients. Conclusion: Lympho scintigraphy using the double tracer technique allows an accu rate correlation of lymphatic drainage to the six cervical compartments. This may provide the basis for a re-evaluation of its impact in treatment planning of patients with head and neck tumors.

Evaluation of the Efficacy of a Small CdTe γ-Camera for Sentinel Lymph Node Biopsy

“…Sentinel lymph node biopsy is an established and widely available procedure for breast cancer and melanoma (16)(17)(18)(19)(20)(21)(22)(23)(24)(25). It is also used for the management of head and neck cancer and other malignancies.…”

“…In breast cancer, the doses of injected radiopharmaceuticals have been reported to be 5-10 MBq (18), [10][11][12][13][14][15][16][17][18][19][20], and 3.7-111 MBq (20). Similar doses (15-111 MBq) have been used for the procedure in patients who have oral cancer (21)(22)(23)(24)(25).…”

Computed tomography and lymphoscintigraphy to identify lymph node metastases and lymphatic drainage pathways in oral and oropharyngeal squamous cell carcinomas

“…Lymphatic drainage of the head and neck is variable among individuals, and it is related to the anatomic site. In 1999, Klutmann et al [7] also considered it to be more difficult to inject the radiopharmaceuticals into the buccal mucosa than into the skin, and they attributed the main factor for non-migration in 44.4% of the cases involving the lateral border of the tongue to be the size of the tumor. The results of this work indicate that some factors, such as tumor location and size and the presence of neck metastases, can be related to the pattern of the lymphoscintigraphic results.…”

The history of sentinel node biopsy in head and neck cancer: From visualization of lymphatic vessels to sentinel nodes

“…Unexpected drainage was found in 17 (23%) of these patients with clinically negative or positive necks. The investigators stated that aberrant lymphatic drainage may have impact on treatment planning for the individual patient [27]. These lymphoscintigraphy studies using peritumoral injections serve nowadays as bases for identification of the SN.…”

“…An average of 4.8 nodes per patient were visualized on the affected side and 5.5 on the healthy side. Klutmann et al [27] observed lymphatic drainage in 53 of 75 (71%) head and neck squamous cell carcinoma (HNSCC) patients after peritumoral injections of 99m Tc-labeled colloid. Unexpected drainage was found in 17 (23%) of these patients with clinically negative or positive necks.…”