Intraoperative lymphatic mapping in cases of midline squamous cell carcinoma.
OBJECTIVE
To analyze the value of intraoperative lymphatic mapping in cases of midline primary head and neck squamous cell carcinoma (HNSCC) in clinically staged N0 necks.


METHODS
Eleven patients with HNSCC of the epiglottis (2 T1, 6 T2, 3 T3), all of whom were staged with a neck status of N0 using sonography and CT, underwent intraoperative peritumoral (99m)Tc-nanocoll injection (4 sites; 45 MBq), radiolabeled detection and analysis of up to 3 hot sentinel nodes (SNs) during elective neck dissection.


RESULTS
Gamma probe use revealed bi- and unilateral intranodal tracer uptake in 6/11 and 5/11 patients, respectively. In 2/6 patients with bilateral intranodal tracer uptake an SN with an isolated metastasis was found at one neck site while the other four patients were tumor-free in the SNs. Of the five patients with unilateral intranodal tracer uptake, three had radiolabeled SNs containing isolated metastases whereas two had no cancer detected, giving a total occult cancer rate of 45% (5/11). No cancer was found in non-labeled nodes.


CONCLUSIONS
Intraoperative lymphatic mapping correctly identified the stage of metastatic disease. Unilateral tracer uptake represented the pathway of occult metastatic spread in 3/5 patients and the disease-free neck status of both neck sites in 2/5 patients. No patient had occult bilateral cancer. Future investigations should be done to determine whether intraoperative lymphoscintigraphy can guide the indication for unilateral only or bilateral neck dissection in these patients.
Werner
Jochen A
JA
Department of Otolaryngology, Head and Neck Surgery, Philipps University of Marburg, Marburg, Germany. wernerj@med.uni-marburg.de
Dünne
A A
AA
Davis
R K
RK
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009333:Neck; D037981:Neck Dissection; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D013668:Technetium Tc 99m Aggregated Albumin; D014062:Tongue Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*
D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid