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

PURPOSENuclear 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 injectio...

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Published in:	Clinical nuclear medicine Vol. 41; no. 7; pp. 534 - 542
Main 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
Format:	Journal Article
Language:	English
Published:	United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-07-2016 Lippincott, Williams & Wilkins
Subjects:	Adult Aged Aged, 80 and over Automatic Carcinoma, Squamous Cell - diagnostic imaging Carcinoma, Squamous Cell - pathology Carcinoma, Squamous Cell - secondary Engineering Sciences Female Humans Lymph Nodes - pathology Lymphatic Metastasis - diagnostic imaging Lymphatic Metastasis - pathology Lymphoscintigraphy - methods Male Middle Aged Mouth Neoplasms - diagnostic imaging Mouth Neoplasms - pathology Neck - pathology Nuclear Medicine Radionuclide Imaging Radiopharmaceuticals - administration & dosage Sentinel Lymph Node - diagnostic imaging Single Photon Emission Computed Tomography Computed Tomography Surveys and Questionnaires
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Summary:	PURPOSENuclear 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. METHODSThree 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. RESULTSLymphoscintigraphy 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. CONCLUSIONSBest 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0363-9762 1536-0229
DOI:	10.1097/RLU.0000000000001241