Lymphoscintigraphy and radioguided sentinel node biopsy in oral cavity squamous cell carcinoma: same day protocol (original) (raw)
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European Archives of Oto-Rhino-Laryngology, 2020
Purpose Data from literature show a mean incidence of occult metastases of 33% in early OCSCC. The gold standard for most authors is a selective neck dissection and a routine pathological examination. 60-70% of unnecessary neck dissections with associated morbidity, can be avoided by using SNB. The aim of this study is to present the results of one of the major Italian centres for the SNB procedure, reserving neck dissection only for proven positive lymphatic metastases. Methods From July 2004 to March 2015, 48 patients with transorally resectable cT1-T2N0 oral SCC were submitted to a lymphoscintigraphic examination one-three hours before surgery and a radio-guided SNB (same day protocol). Patients with a negative SNB were checked every 3 months by ultrasound examination. The minimum follow-up was 5 years. Results Sentinel nodes were found in all cases, with 71% localized in the ipsilateral neck only in levels I-II. Metastases were found in 15 out of 48 cases (31.2%), on levels I, II and III. Further metastatic nodes were found in 6 cases in the neck dissection specimen. In the cohort of 33 patients with SNB negative at 5 years, no-one had a recurrence on the ipsilateral neck. Conclusion This study confirms the accuracy of SNB in predicting the presence of occult metastases, sparing the need for unnecessary neck dissection in 70% of cases. The same day protocol is designed to detect sentinel nodes, which are almost always on neck level I-II, thereby limiting the number of nodes examined and the extension of the surgical approach.
Predictive value of sentinel node biopsy in head and neck cancer
Acta Oto-Laryngologica, 2008
Conclusions. The negative predictive value (NPV) of sentinel lymph node biopsy (SNB) in this study was 95%. The accuracy of SNB compared to histopathologic evaluation of surgical specimen of subsequent neck dissection (ND) was 96%. Objective. To evaluate NPV of SNB in head and neck cancer. Patients and methods. This was a prospective clinical study comprising 35 patients (50 necks) with squamous cell carcinoma (SCC) of head and neck with clinically (cN0) and radiologically negative necks, without previous treatment, who underwent SNB with gamma probe and subsequent ND. The NPV, accuracy, sensitivity, and specificity of SNB were compared to histopathologic assessment of surgical specimens from NDs. Negative sentinel lymph nodes (SLNs) on histopathology were evaluated with step serial section (SSS) and immunohistochemistry (IHC). When a neck had a positive SLN, all lymph nodes of subsequent NDs were studied with SSS and IHC. Results. There were primaries of the oral cavity (n 024), lip (n03), oropharynx (n03), and larynx (n 05). All patients had detected SLNs. In all, 41 necks were SLN-negative on histopathologic evaluation but 2 (5%) had metastases in non-SLNs after ND. Of these 41 necks, SLNs were level Ib (26%), IIa (45%), III (21%), and IV (8%). Nine necks presented positive SLN on histopathologic evaluation, level Ib (n 03), IIa (n05), and III (n 02), and subsequent NDs were negative on conventional histopathologic analysis, but after SSS and IHC, two presented micrometastases.
European Archives of Oto-Rhino-Laryngology, 2008
Sentinel lymph node biopsy (SNB) seems to be a promising method for staging clinically N0 neck in patients with oral squamous cell carcinoma (OSCC). In the present study, SNB was performed on 46 patients having elective neck dissection (END; six bilateral dissections) for T1-T3N0 OSCC. Sentinel lymph nodes (SLN) were Wrst examined according to only slightly modiWed standard histopathologic protocol including sections at 1-2 mm intervals and H&E staining. SLN that appeared false negative (i.e. metastatic non-SLN without metastasis in a SLN) after the initial histopathologic examination were further assessed by step sectioning at 150 m intervals and immu-nohistochemistry. Of the 47 neck sides with at least one SLN identiWed, nine contained metastasis in nine patients. After the initial histopathologic examination, SLNs were negative for malignant cells in four out of the nine metastatic neck sides. In one neck side, two metastatic SLNs were detected after the additional meticulous histopathologic work-up of the initially false negative SLNs. Therefore, in three neck sides the SLN did not contain metastasis although there was a metastasis in a non-SLN. In all these three cases with a false negative SLN, only one SLN had been identiWed. The sensitivity of the method (employing extensive histopathologic work-up) for detection of occult cervical metastasis was 67% (6/9 neck sides). The sensitivity of SNB for detection of occult metastasis seems to be poor in cases where only one SLN can be identiWed. The results of this study do not entitle us to entirely replace END by SNB in patients with OSCC.
Clinical Nuclear Medicine, 2016
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.
Sentinel Lymph Node Radiolocalization in Head and Neck Squamous Carcinoma: Curious Methods
Dear Editor: For head and neck squamous cell carcinoma, as well as for most solid tumors, the presence of lymph node metastasis is the most important prognostic factor. The morbidity, and possibly the lack of therapeutic benefit, of elective lymph node dissection in N0 patients for breast cancer and melanoma have made minimally invasive approaches attractive. In this context, the sentinel node (SLN) concept was formulated, first by Cabanas 1 for pe-nile squamous cell and later by Morton 2 for melanoma and Giuliano 3 for breast carcinoma. The SLN concept supposes that the oncologic status of one or few lymph nodes can predict the presence of meta-static disease in the remaining lymph nodes of the draining basin. The strongest point in the SLN concept is that a negative SLN biopsy should predict the absence of meta-static cells in the entire regional lymph basin. The SLN concept can be considered validated for breast carcinoma, 4 and although it has been accepted as the standard of care for melanoma, it has not been formally validated. 4 – 6 The sentinel node concept is a hypothesis and as such has to be validated or proven before it can be applied for every type of cancer histology and location. Early studies in head and neck squamous cell carcinoma 7–9 were not very successful in identifying the SLN, probably because of inadequate timing of injection and dissection and the difficulty of separating the gamma signal of the primary from that of the SLN. In a recent study, Alex et al. 10 have reported a 100% SLN detection rate and no false-positives in eight patients. 99m Technetium sulfur colloid was used as the sole tracer and the detection was performed with a handheld gamma probe, without preoperative lympho-scintigraphy. Although these results are encouraging and should incite others to pursue the technique, several points need clarification: 1. In this study, the SLN was determined and excised on the neck dissection specimen rather than in vivo. We are surprised that pioneers of the SLN technique, such as Alex and Krag, 11 would use such an approach and not even mention it in the discussion. Although this technique might be used during a training phase, it should not be recommended and is not useful to validate the SLN concept. 2. The SLN concept is thoroughly tested only when the dissection of the regional basin reveals other metastatic lymph nodes, as pointed out by Krag 5 and others. 4 For the article by Alex et al., this amounts to no false-negatives in one patient! 3. Despite these shortcomings, the authors propose a nice and logical algorithm that is used in breast carcinoma, after its validation by numerous studies , and prematurely in melanoma. We would like to warn head and neck surgeons that the SLN concept should be considered as experimental for head and neck squamous cell carcinoma and needs to be proven before it can be used routinely in clinical practice. Let us learn the mistakes of others and not take the shortcut that melanoma surgeons might regret. The standard of care in head and neck squamous cell carcinoma is still a neck dissection, until a large and preferably multi-institutional study validates the SLN concept.
Sentinel Lymph Node Biopsy: A new approach in the management of head and neck cancers
Sultan Qaboos University Medical Journal, 2017
Cervical lymph node metastasis affects the prognosis and overall survival rate of and therapeutic planning for patients with head and neck squamous cell carcinomas (HNSCCs). However, advanced diagnostic modalities still lack accuracy in detecting occult neck metastasis. A sentinel lymph node biopsy is a minimally invasive auxiliary method for assessing the presence of occult metastatic disease in a patient with a clinically negative neck. This technique increases the specificity of neck dissection and thus reduces morbidity among oral cancer patients. The removal of sentinel nodes and dissection of the levels between the primary tumour and the sentinel node or the irradiation of target nodal basins is favoured as a selective treatment approach; this technique has the potential to become the new standard of care for patients with HNSCCs. This article presents an update on clinical applications and novel developments in this field.
Sentinel Node Localization in Oral Cavity and Oropharynx Squamous Cell Cancer
Archives of Otolaryngology–Head & Neck Surgery, 2001
Objective: To evaluate the feasibility and predictive ability of the sentinel node localization technique for patients with squamous cell carcinoma of the oral cavity or oropharynx and clinically negative necks. Design: Prospective, efficacy study comparing the histopathologic status of the sentinel node with that of the remaining neck dissection specimen. Setting: Tertiary referral center. Patients: Patients with T1 or T2 disease and clinically negative necks were eligible for the study. Nine previously untreated patients with oral cavity or oropharyngeal squamous cell carcinoma were enrolled in the study. Interventions: Ulfiltered technetium Tc 99m sulfur colloid injections of the primary tumor and lymphoscintigraphy were performed on the day before surgery. Intraoperatively, the sentinel node(s) was localized with a gamma probe and removed after tumor resection and before neck dissection. Main Outcome Measures: The primary outcome was the negative predictive value of the histopathologic status of the sentinel node for predicting cervical metastases. Results: Sentinel nodes were identified in 9 previously untreated patients. In 5 patients, there were no positive nodes. In 4 patients, the sentinel nodes were the only histopathologically positive nodes. In previously untreated patients, the sentinel node technique had a negative predictive value of 100% for cervical metastasis. Conclusions: Our preliminary investigation shows that sentinel node localization is technically feasible in head and neck surgery and is predictive of cervical metastasis. The sentinel node technique has the potential to decrease the number of neck dissections performed in clinically negative necks, thus reducing the associated morbidity for patients in this group.
Sentinel Lymph Node Biopsy in SCC of the Head and Neck: A Major Advance in Staging the NO Neck
Ear, Nose & Throat Journal, 2002
The management of the NO neck in patients with head and neck cancer is controversial. Neck dissection provides important staging information that guides patient treatment. We examined the feasibility of using a dye technique for staging patients by sentinel lymph node biopsy (SLNBX). We studied seven patients with previously untreated early-stage squamous cell carcinoma of the oral cavity and NO necks. Each patient underwent SLNBX guided by an intraoperative injection of 1% isosulfan blue dye. An open biopsy of the sentinel node was followed by neck dissection. We identified the sentinel node in four of the seven patients (57%). The sentinel node accurately predicted the pathologic status of the neck in three of these four patients (75%). In one of the three patients, the sentinel node was one of four histopathologically positive nodes, whereas in two others, the neck was free of disease. One patient had a histopathologically negative sentinel node and tumor metastasis present in th...
Sentinel lymph node biopsy in SCC of the head and neck: a major advance in staging the N0 neck
Ear, nose, & throat journal, 2002
The management ofthe NOneck in patients with head and neck canc er is controv ersial. Neck dissection pro vides important staging information that guides pati ent treatment. We examined thefeasibility ofusing a dye technique for staging patients by sentine l lymph node biopsy (SLNBX). We studied seven patients with previously untreated early-stage squam ous cell carci noma of the oral cavity and NO necks. Each patient underw ent SLNBX guid ed by an intraoperative injection of 1% isosulfan blue dye. An open biop sy ofthe sentinel node was followed by neck dissection. We identifi ed the sentinel node info ur of the seven patients (57%). The sentinel node accurately predicted the pathologic status of the neck in three of these four patients (75 %).1n one ofthe three patients, the sentinel node was one offour histopathologically positive nodes , whereas in two others , the neck wasfree ofdiseas e.