title: Fusion of Freehand SPECT and Ultrasound to Perform Ultrasound-Guided Fine-Needle Aspiration Cytology of Sentinel Nodes in Head and Neck Cancer.
abstract: OBJECTIVE
  Criteria for ultrasound-guided fine-needle aspiration cytology (USgFNAC) for the detection of occult lymph node metastasis in patients with clinically negative head and neck cancer are based on the morphology of cervical lymph nodes. To improve the selection of lymph nodes for USgFNAC, we examined the feasibility of fused freehand single-photon emission tomography ultrasound-guided fine-needle cytology (freehand SPECT-USgFNAC) of sentinel nodes in patients with early stage oral and head and neck skin cancer.
  
  
  METHODS
  Six patients with early-stage head and neck cancer (4 oral and 2 head and neck skin cancers) and a clinically negative neck who were scheduled for transoral or local excision and a sentinel node procedure underwent USgFNAC and freehand SPECT-USgFNAC preoperatively.
  
  
  RESULTS
  All freehand SPECT sonographic examinations were technically successful in terms of identifying sentinel nodes. All aspirates of sentinel nodes obtained by freehand SPECT-USgFNAC contained substantial radioactivity, confirming puncture of the sentinel nodes. USgFNAC evaluated 13 lymph nodes; freehand SPECT-USgFNAC, 19 nodes; and sentinel node biopsy, 13 nodes. Three sentinel nodes were histopathologically positive and were selected for aspiration cytology by freehand SPECT-USgFNAC, but not by conventional ultrasound. The cytologic examination findings of the aspirations were negative or inconclusive.
  
  
  CONCLUSIONS
  Freehand SPECT ultrasound can identify sentinel nodes and could potentially improve USgFNAC in patients with head and neck cancer by better selection of lymph nodes at highest risk of having metastases (sentinel nodes), but its sensitivity is limited by sampling error and insufficient aspirated material for cytology.
authors: From the Departments of Otolaryngology-Head and Neck Surgery (R.d.B., D.A.H.) Department of Head and Neck Surgical Oncology (R.d.B.), UMC Utrecht Cancer Center, Utrecht, the Netherlands r.debree@umcutrecht.nl.
authors: R
authors: R
authors: de Bree
authors: Department of Nuclear Medicine (B.P.), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
authors: B
authors: B
authors: Pouw
authors: From the Departments of Otolaryngology-Head and Neck Surgery (R.d.B., D.A.H.).
authors: D A
authors: DA
authors: Heuveling
authors: Radiology and Nuclear Medicine (J.A.C.), VU University Medical Center, Amsterdam, the Netherlands.
authors: J A
authors: JA
authors: Castelijns
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D000077195:Squamous Cell Carcinoma of Head and Neck; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*