title: Evaluation of the use of freehand SPECT for sentinel node biopsy in early stage oral carcinoma.
abstract: BACKGROUND
  Inadequate intraoperative visualization of the sentinel node can hamper its harvest. Freehand SPECT is a 3D tomographic imaging modality based on the concepts of SPECT, which can be used for intraoperative visualization and navigation towards the sentinel node in order to improve its localization and removal during surgery.
  
  
  METHODS
  The use of freehand SPECT was evaluated during 66 sentinel node biopsy procedures in early stage oral cancer patients. Intraoperative detection of sentinel nodes was compared with preoperative identified sentinel nodes on lymphoscinitigraphic examination. Additional value of freehand SPECT was subjectively scored by the surgeon directly following the biopsy procedure.
  
  
  RESULTS
  Freehand SPECT was able to detect 94% of sentinel nodes intraoperatively. Most sentinel nodes not detected (7 out of 9) were located in level I of the neck. Freehand SPECT appeared to be of additional value for facilitating the intraoperative detection of the sentinel node in 24% of procedures.
  
  
  CONCLUSIONS
  The use of the freehand SPECT system is feasible in the intraoperative detection of sentinel nodes in early stage oral cancer. Freehand SPECT provides helpful information facilitating the SN biopsy procedure in a quarter of cases. However, freehand SPECT cannot detect all SNs which are located in the vicinity of the injection site.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Derrek A
authors.initials: DA
authors.lastname: Heuveling
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Stijn
authors.initials: S
authors.lastname: van Weert
authors.affiliation: Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands.
authors.forename: K Hakki
authors.initials: KH
authors.lastname: Karagozoglu
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: r.bree@vumc.nl.
authors.forename: Remco
authors.initials: R
authors.lastname: de Bree
mesh_terms: D005240:Feasibility Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging*; D009333:Neck; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000295:instrumentation / Q000379:methods*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: 3D; Freehand SPECT; Oral cancer; Sentinel lymph node biopsy