TY - JOUR

T1 - Sentinel Node in Oral Cancer

T2 - The Nuclear Medicine Aspects. A Survey from the Sentinel European Node Trial

AU - Tartaglione, Girolamo

AU - Stoeckli, Sandro J

AU - de Bree, Remco

AU - Schilling, Clare

AU - Flach, Geke B

AU - Bakholdt, Vivi T.

AU - Sorensen, Jens Ahm

AU - Bilde, Anders

AU - von Buchwald, Christian

AU - Lawson, Georges

AU - Dequanter, Didier

AU - Villarreal, Pedro M

AU - Forcelledo, Manuel Florentino Fresno

AU - Amézaga, Julio Alvarez

AU - Moreira, Augusto

AU - Poli, Tito

AU - Grandi, Cesare

AU - Vigili, Maurizio Giovanni

AU - O'Doherty, Michael J

AU - Donner, Davide

AU - Bloemena, Elisabeth

AU - Rahimi, Siavash

AU - Gurney, Benjamin A S

AU - Haerle, Stephan K

AU - Broglie, Martina A

AU - Huber, Gerhard F

AU - Krogdah, Annelise L

AU - Sebbesen, Lars R

AU - Odell, Edward

AU - Junquera Gutiérrez, Luis Manuel

AU - Barbier Herrero, Luis

AU - Santamaría-Zuazua, Joseba

AU - Jacome, Manuel

AU - Nollevaux, Marie-Cecile

AU - Bragantini, Emma

AU - Lothaire, Philippe

AU - Silini, Enrico M

AU - Sesenna, Enrico

AU - Dolivet, Giles

AU - Mastronicola, Romina

AU - Leroux, Agnes

AU - Sassoon, Isabel

AU - Sloan, Philip

AU - Colletti, Patrick M

AU - Rubello, Domenico

AU - McGurk, Mark

PY - 2016

Y1 - 2016

N2 - 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.

AB - 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.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Carcinoma, Squamous Cell

KW - Female

KW - Humans

KW - Lymph Nodes

KW - Lymphatic Metastasis

KW - Lymphoscintigraphy

KW - Male

KW - Middle Aged

KW - Mouth Neoplasms

KW - Neck

KW - Nuclear Medicine

KW - Radionuclide Imaging

KW - Radiopharmaceuticals

KW - Sentinel Lymph Node

KW - Single Photon Emission Computed Tomography Computed Tomography

KW - Surveys and Questionnaires

KW - Journal Article

KW - Multicenter Study

U2 - 10.1097/RLU.0000000000001241

DO - 10.1097/RLU.0000000000001241

M3 - Journal article

C2 - 27088386

VL - 41

SP - 534

EP - 542

JO - Clinical Nuclear Medicine

JF - Clinical Nuclear Medicine

SN - 0363-9762

IS - 7

ER -