title: Visualization of the sentinel node in early-stage oral cancer:  limited value of late static lymphoscintigraphy.
abstract: OBJECTIVE
  Various lymphoscintigraphic imaging protocols exist for sentinel node (SN) identification in early-stage oral cancer. This study aimed to evaluate the clinical value of performing additional late lymphoscintigraphic imaging.
  
  
  METHODS
  We retrospectively analysed early (directly following injection of 99mTc-Nanocoll) and late (2-4 h after injection) imaging results of 60 early-stage (T1-T2, cN0) oral cancer patients scheduled for SN procedure. Lymphoscintigraphic results of late imaging were categorized into: (a) no visualization of additional hotspots considered to be SNs; (b) additional hotspots visualized that are considered to be SNs and (c) hotspots visualized only during late imaging. Histopathological results of the harvested SNs were related to the corresponding hotspot.
  
  
  RESULTS
  In all patients (n=60) lymphoscintigraphy was able to visualize a hotspot that was identified as an SN. In 51/60 (85%) patients, early imaging was able to visualize at least one hotspot, whereas in 9/60 (15%) patients, mostly with oral cavity tumours other than mobile tongue and floor-of-mouth tumours, only late imaging was able to visualize hotspots. In 14/51 (27%) patients, late imaging resulted in additionally visualized hotspots marked as SNs, resulting in a more extensive surgical procedure. These additionally removed SNs appeared to be of no clinical relevance, as all SNs identified during early imaging correctly predicted whether the neck was positive or negative for cancer.
  
  
  CONCLUSIONS
  Results of this study indicate that additional late lymphoscintigraphic imaging should be performed only in selected cases.
authors: Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
authors: Derrek A
authors: DA
authors: Heuveling
authors: Géke B
authors: GB
authors: Flach
authors: Annelies
authors: A
authors: van Schie
authors: Stijn
authors: S
authors: van Weert
authors: K Hakki
authors: KH
authors: Karagozoglu
authors: Elisabeth
authors: E
authors: Bloemena
authors: C René
authors: CR
authors: Leemans
authors: Remco
authors: R
authors: de Bree
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007267:Injections; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D009367:Neoplasm Staging; D012189:Retrospective Studies