Lymphoscintigraphy and radioguided sentinel node biopsy in oral cavity squamous cell carcinoma: same day protocol.
The routine use of a sentinel node biopsy (SNB) protocol in oral cavity squamous cell carcinomas (SCC) has been challenged on the basis of the elevated number of sentinel nodes (SNs) detected (>2.5) and on the multiply neck level involvement reported in several studies. These data limit the practical application of the protocol, because in such cases, it seems easier and safer to perform a selective neck dissection. The aim of our study is to perform radioguided surgery 1-3 h after lymphoscintigraphy (same day protocol) to detect the lymph nodes closest to the tumour site. In our study, 12 patients affected by cT1-2 N0 SCC of the oral cavity were submitted to a same day protocol of a lymphoscintigraphic examination (1-3 h before surgery) and a radioguided SNB. We used a hand-held gamma probe and performed an elective neck dissection on all patients. The SNs were found in all cases with 83% localised in the ipsilateral neck in only levels I-II. The mean number of SN detected was 2.1, with a mean pathological size of 13.8 mm measured on pathological specimen. Metastases were found in 5/12 cases (41.6%), on levels I, II and III and all were identified by step serial sectioning and routine H&E staining. This study confirms the accuracy of SNB in predicting the presence of occult metastases. This protocol is designed to detect SNs, which are almost always on neck level I and II, thereby limiting the number of nodes examined and the extension of the surgical approach.
Vigili
Maurizio Giovanni
MG
Department of Otolaryngology, San Carlo IDI-IRCCS Hospital Rome, Via Aurelia 275, 00165, Rome, Italy. vigili@idi.it
Tartaglione
Girolamo
G
Rahimi
Siavash
S
Mafera
Barbara
B
Pagan
Marco
M
D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011859:Radiography; D011877:Radionuclide Imaging; D021701:Sentinel Lymph Node Biopsy / Q000295:instrumentation*; 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