An innovative multimodality approach for sentinel node mapping and biopsy in head and neck malignancies.
OBJECTIVE
Recent innovations such as preoperative SPECT/CT, intraoperative imaging using portable devices and a hybrid tracer were evaluated in a multimodality approach for sentinel node (SN) mapping and biopsy in head and neck malignancies.


METHODS
The evaluation included 25 consecutive patients with head and neck malignancies (16 melanomas and 9 oral cavity squamous cell carcinomas). Patients were peritumorally injected with the hybrid tracer ICG-(99m)Tc-nanocolloid. SNs were initially identified with lymphoscintigraphy followed by single photon emission computed tomography (SPECT/CT) 2 hours after tracer administration. During surgery a portable gamma camera in combination with a near-infrared fluorescence camera was used in addition to a handheld gamma ray detection probe to locate the SNs.


RESULTS
In all patients the use of conventional lymphoscintigraphy, SPECT/CT and the additional help of the portable gamma camera in one case were able to depict a total of 67 SNs (55 of them visualized on planar images, 11 additional on SPECT/CT and 1 additional with the portable gamma camera). A total of 67 of the preoperatively defined SNs together with 22 additional SNs were removed intraoperatively; 12 out of the 22 additional SNs found during operation were located in the vicinity of the injection site in anatomical areas such as the periauricular or submental regions. The other 10 additional SNs were found by radioguided post-resection control of the excision SN site.


CONCLUSIONS
In the present series 26% additional SNs were found using the multimodal approach, that incorporates SPECT/CT and intraoperative imaging to the conventional procedure. This approach appears to be useful in malignancies located close to the area of lymphatic drainage such as the periauricular area and the oral cavity.
Servicio de Medicina Nuclear, Hospital Universitario Virgen Macarena, Sevilla, España; Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. Electronic address: m_borbon@hotmail.com.
M
M
Borbón-Arce
Servicio de Medicina Nuclear, Hospital Universitario Virgen Macarena, Sevilla, España.
O R
OR
Brouwer
Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Radiology, Leiden University Medical Centre, Leiden, Netherlands.
N S
NS
van den Berg
Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
H
H
Mathéron
Department of Head & Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
W M C
WM
Klop
Department of Head & Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
A J M
AJ
Balm
Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Head & Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
F W B
FW
van Leeuwen
Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Radiology, Leiden University Medical Centre, Leiden, Netherlands.
R A
RA
Valdés-Olmos
D000328:Adult; D000368:Aged; D005260:Female; D015902:Gamma Cameras; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D061305:Lymphoscintigraphy; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D015899:Tomography, Emission-Computed, Single-Photon
Abordaje multimodalidad; Cabeza y cuello; Carcinoma de células escamosas; Ganglio centinela; Head and Neck; Melanoma; Multimodality approach; SPECT/TAC; Sentinel node; Squamous cell Carcinoma