Sentinel Node in Oral Cancer: The Nuclear Medicine Aspects. A Survey from the Sentinel European Node Trial
Journal Paper/Review - Jul 1, 2016
McGurk Mark, Jacome Manuel, Santamaría-Zuazua Joseba, Barbier Luis, Junquera Gutiérrez Luis Manuel, Odell Edward, Sebbesen Lars R, Krogdah Annelise L, Huber Gerhard F, Broglie Däppen Martina, Nollevaux Marie-Cecile, Bragantini Emma, Lothaire Philippe, Rubello Domenico, Colletti Patrick M, Sloan Philip, Sassoon Isabel, Leroux Agnes, Mastronicola Romina, Dolivet Giles, Sesenna Enrico, Silini Enrico M, Haerle Stephan K, Gurney Benjamin, Lawson Georges, von Buchwald Christian, Bilde Anders, Sorensen Jens Ahm, Bakholdt Vivi, Flach Géke B, Schilling Clare, de Bree Remco, Stöckli Sandro, Dequanter Didier, Villarreal Pedro M, Forcelledo Manuel Florentino Fresno, Rahimi Siavash, Bloemena Elisabeth, Donner Davide, O'Doherty Michael, Vigili Maurizio Giovanni, Grandi Cesare, Poli Tito, Moreira Augusto, Amézaga Julio Alvarez, Tartaglione Girolamo
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.
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.
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.
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.