Sentinel Node in Oral Cancer: The Nuclear Medicine Aspects. A Survey from the Sentinel European Node Trial. (July 2016)

• Record Type: Journal Article
• Authors: Tartaglione, Girolamo; Stoeckli, Sandro J.; de Bree, Remco; Schilling, Clare; Flach, Geke B.; Bakholdt, Vivi; Sorensen, Jens Ahm; Bilde, Anders; von Buchwald, Christian; Lawson, Georges; Dequanter, Didier; Villarreal, Pedro M.; Forcelledo, Manuel Florentino Fresno; Amezaga, Julio Alvarez; Moreira, Augusto; Poli, Tito; Grandi, Cesare; Vigili, Maurizio Giovanni; O'Doherty, Michael; Donner, Davide; Bloemena, Elisabeth; Rahimi, Siavash; Gurney, Benjamin; Haerle, Stephan K.; Broglie, Martina A.; Huber, Gerhard F.; Krogdah, Annelise l.; Sebbesen, Lars R.; Odell, Edward; Junquera Gutierrez, Luis Manuel; Barbier, Luis; Santamaria-Zuazua, Joseba; Jacome, Manuel; Nollevaux, Marie-Cecile; Bragantini, Emma; Lothaire, Philippe; Silini, Enrico M.; Sesenna, Enrico; Dolivet, Giles; Mastronicola, Romina; Leroux, Agnes; Sassoon, Isabel; Sloan, Philip; Colletti, Patrick M.; Rubello, Domenico; McGurk, Mark;
• Is Part Of: Clinical nuclear medicine. Volume 41:Number 7(2016)
• Publication Date: 2016-07
• Subjects: squamous cell carcinoma -- sentinel lymph nodes -- lymphoscintigraphy -- single-photon emission computed tomography -- head and neck cancer -- gamma probe -- sentinel lymph node biopsy -- lymphatic metastasis -- neck dissection; Nuclear medicine -- Periodicals; Radioisotope scanning -- Periodicals; Nuclear Medicine -- Periodicals; 616.07575
• DOI: 10.1097/RLU.0000000000001241
• Languages: English
• ISSNs: 0363-9762

Abstract

Abstract : Purpose: Nuclear imaging plays a crucial role in lymphatic mapping of oral cancer. This evaluation represents a subanalysis of the original multicenter SENT trial data set, involving 434 patients with T1-T2, N0, and M0 oral squamous cell carcinoma. The impact of acquisition techniques, tracer injection timing relative to surgery, and causes of false-negative rate were assessed. Methods: Three to 24 hours before surgery, all patients received a dose of 99m Tc-nanocolloid (10–175 MBq), followed by lymphoscintigraphy. According to institutional protocols, all patients underwent preoperative dynamic/static scan and/or SPECT/CT. Results: Lymphoscintigraphy identified 723 lymphatic basins. 1398 sentinel lymph nodes (SNs) were biopsied (3.2 SN per patient; range, 1–10). Dynamic scan allowed the differentiation of sentinel nodes from second tier lymph nodes. SPECT/CT allowed more accurate anatomical localization and estimated SN depth more efficiently. After pathological examination, 9.9% of the SN excised (138 of 1398 SNs) showed metastases. The first neck level (NL) containing SN+ was NL I in 28.6%, NL IIa in 44.8%, NL IIb in 2.8%, NL III in 17.1%, and NL IV in 6.7% of positive patients. Approximately 96% of positive SNs were localized in the first and second lymphatic basin visualized using lymphoscintigraphy. After neck dissection, the SN+ was the only lymph node containing metastasis in approximately 80% of patients. Conclusions: Best results were observed using a dynamic scan in combination with SPECT/CT. A shorter interval between tracer injection, imaging, and surgery resulted in a lower false-negative rate. At least 2 NLs have to be harvested, as this may increase the detection of lymphatic metastases.