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

Clin Nucl Med 2016 Jul;41(7):534-42

From the *Department of Nuclear Medicine, Cristo Re Hospital, Rome, Italy; †Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St Gallen, St Gallen, Switzerland; ‡Department of Head and Neck Surgical Oncology, UMCU Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands; §Department of Head and Neck Surgery, Guys and St Thomas NHS Trust, London, UK; ∥Department of Plastic and Reconstructive Surgery, Odense University Hospital, Odense, Denmark; ¶Department of Otolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark; **Department of Head and Neck Surgery, CHU Dinant Godinne, Université Catholique de Louvain, Belgium; ††Department of Maxillofacial Surgery, CHU de Charleroi Belgium, Belgium; ‡‡Department of Maxillofacial Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain; §§Department of Pathology, Hospital Universitario Central de Asturias, Oviedo, Spain; ∥∥Department of Maxillofacial Surgery, BioCruces, Hospital Universitario De Cruces, Universidad del Pais Vasco (UPV/EHU), Bilbao, Spain; ¶¶Department of Head and Neck Surgery, Instituto Portugues de Oncologia do Porto, Portugal; ***Department of Maxillofacial Surgery, Azienda Ospedaliera, Universitaria di Parma, Parma, Italy; †††Department of Otolaryngology, Ospedale S. Chiara, Trento, Italy; ‡‡‡Department of Otorhinolaryngology, San Carlo Hospital, Rome, Italy; §§§Department of Nuclear Medicine, Guys and St Thomas NHS Trust, London, UK; ∥∥∥Department of Nuclear Medicine, Ospedale S. Chiara, Trento, Italy; ¶¶¶Department of Pathology, VU University Medical Centre and Academic Centre of Dentistry Amsterdam, Amsterdam, The Netherlands; ****Pathology Centre, Queen Alexandra Hospital, Portsmouth, UK; ††††Department of Head and Neck Surgery, University of Basel, Basel, Switzerland; ‡‡‡‡Department of Otolaryngology, University Hospital Zurich, Zurich, Switzerland; §§§§Dep

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 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.

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http://dx.doi.org/10.1097/RLU.0000000000001241DOI Listing
July 2016
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