title: Freehand SPECT-guided sentinel lymph node biopsy in early oral squamous cell carcinoma.
abstract: BACKGROUND
  In oral squamous cell carcinoma (OSCC), cervical lymph node status is the most important prognostic factor. Compared to elective neck dissection, reduced morbidity and better quality of life was demonstrated for sentinel lymph node biopsy, which is controversial because of the reduced detection rate of sentinel lymph nodes in close proximity to the injection site (also known as the shine-through phenomenon).
  
  
  METHODS
  We report the case of a 44-year-old woman with a biopsy-proven early OSCC of the anterior floor of the mouth, who received SLNB guided with freehand single-photon emission CT (fhSPECT), a system for the 3D visualization of radioactivity in the body.
  
  
  RESULTS
  One level III sentinel lymph node and 1 level I sentinel lymph node, in close proximity to the injection site, were detected and dissected. The level I sentinel lymph node contained a metastasis.
  
  
  CONCLUSIONS
  Using fhSPECT, the issue outlined was overcome, and the precise histopathological lymph node status (pN1; 1 of 49) was determined.
authors.affiliation: Department of Nuclear Medicine, University Hospital of Würzburg, Würzburg, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Bluemel
authors.forename: Ken
authors.initials: K
authors.lastname: Herrmann
authors.forename: Urs
authors.initials: U
authors.lastname: Müller-Richter
authors.forename: Constantin
authors.initials: C
authors.lastname: Lapa
authors.forename: Takahiro
authors.initials: T
authors.lastname: Higuchi
authors.forename: Vanessa
authors.initials: V
authors.lastname: Wild
authors.forename: Andreas K
authors.initials: AK
authors.lastname: Buck
authors.forename: Alexander
authors.initials: A
authors.lastname: Kübler
authors.forename: Christian
authors.initials: C
authors.lastname: Linz
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology*; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013515:Surgery, Oral / Q000379:methods; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D016896:Treatment Outcome
keywords: freehand single-photon emission CT (fhSPECT); head and neck cancer; neck dissection; sentinel lymph node biopsy; squamous cell carcinoma