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Region Hovedstaden - en del af Københavns Universitetshospital

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

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  • Sandro J Stoeckli
  • Remco de Bree
  • Clare Schilling
  • Geke B Flach
  • Vivi Bakholdt
  • Jens Ahm Sorensen
  • Anders Bilde
  • Christian von Buchwald
  • Georges Lawson
  • Didier Dequanter
  • Pedro M Villarreal
  • Augusto Moreira
  • Tito Poli
  • Cesare Grandi
  • Maurizio Giovanni Vigili
  • Michael O'Doherty
  • Davide Donner
  • Elisabeth Bloemena
  • Siavash Rahimi
  • Benjamin Gurney
  • Stephan K Haerle
  • Martina A Broglie
  • Gerhard F Huber
  • Annelise L Krogdah
  • Lars R Sebbesen
  • Edward Odell
  • Luis Manuel Junquera Gutierrez
  • Luis Barbier
  • Joseba Santamaria-Zuazua
  • Manuel Jacome
  • Marie-Cecile Nollevaux
  • Emma Bragantini
  • Philippe Lothaire
  • Enrico M Silini
  • Enrico Sesenna
  • Giles Dolivet
  • Romina Mastronicola
  • Agnes Leroux
  • Isabel Sassoon
  • Philip Sloan
  • Patrick M Colletti
  • Domenico Rubello
  • Mark McGurk
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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.

TidsskriftClinical Nuclear Medicine
Udgave nummer7
Sider (fra-til)534-42
Antal sider9
StatusUdgivet - jul. 2016

ID: 49659724