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

Abstract

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.

Personalized neck irradiation guided by sentinel lymph node biopsy in patients with squamous cell carcinoma of the oropharynx, larynx or hypopharynx with a clinically negative neck: (Chemo)radiotherapy to the PRIMary tumor only. Protocol of the PRIMO study

“…To visualize SLNs, the radioactive tracer [ 99m Tc]Tc‐Nanocolloid will be used and can optionally be administered together with the fluorescent tracer indocyanine green (ICG) to form the non-covalent bound multimodal tracer ICG-[ 99m Tc]Tc‐Nanocolloid [14] . A flexible endoscopy guide tracer injection under local anesthesia will be performed in the outpatient clinic [15] , [16] . If the tumor is accessible via transoral route, a direct tracer injection will be performed (for selected oropharyngeal tumors).…”

“…To localize SLNs, SPECT/CT imaging will be acquired at 3–4 h after tracer injection [15] . Approximately 2.2 (mean) and 2.7 (mean) SLNs per patient are expected for oropharyngeal and laryngeal/hypopharyngeal cancers respectively [7] , [15] .…”

“…To localize SLNs, SPECT/CT imaging will be acquired at 3–4 h after tracer injection [15] . Approximately 2.2 (mean) and 2.7 (mean) SLNs per patient are expected for oropharyngeal and laryngeal/hypopharyngeal cancers respectively [7] , [15] . For image reading, SPECT, CT and fused SPECT/CT images are displayed using orthogonal multiplanar reconstruction, maximum intensity projection, and volume rendering.…”