title: The added value of SPECT-CT for the identification of sentinel lymph nodes in early stage oral cancer.
abstract: OBJECTIVE
  To assess the role of single-photon emission computed tomography with computed tomography (SPECT-CT) for the identification of sentinel lymph nodes (SLNs) in patients with early stage (T1-T2) oral cancer and a clinically negative neck (cN0).
  
  
  METHODS
  In addition to planar lymphoscintigraphy, SPECT-CT was performed in 66 consecutive patients with early stage oral cancer and a clinically negative neck. The addition of SPECT-CT to planar images was retrospectively analyzed for the number of additional SLNs, more precise localization of SLNs, and importance of anatomical information by a team consisting of a nuclear physician, surgeon, and investigator.
  
  
  RESULTS
  Identification rate for both imaging modalities combined was 98% (65/66). SPECT-CT identified 15 additional SLNs in 14 patients (22%). In 2/15 (13%) of these additional SLNs, the only metastasis was found, resulting in an upstaging rate of 3% (2/65). In 20% of the patients with at least one positive SLN, the only positive SLN was detected due to the addition of SPECT-CT. SPECT-CT was considered to add important anatomical information in two patients (3%). In 5/65 (8%) of the patients initially scored SLNs on planar lymphoscintigrams were scored as non-SLNs when SPECT-CT was added. There were four false-negative SLN biopsy procedures in this cohort.
  
  
  CONCLUSIONS
  The addition of SPECT-CT to planar lymphoscintigraphy is recommended for the identification of more (positive) SLNs and better topographical orientation for surgery in sentinel lymph node biopsy for early stage oral cancer.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.|Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: Inne J
authors.initials: IJ
authors.lastname: den Toom
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Annelies
authors.initials: A
authors.lastname: van Schie
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, Amsterdam, The Netherlands.
authors.forename: K Hakki
authors.initials: KH
authors.lastname: Karagozoglu
authors.affiliation: Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry (ACTA) Amsterdam, Amsterdam, The Netherlands.|Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Bloemena
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Otto S
authors.initials: OS
authors.lastname: Hoekstra
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands. r.debree@umcutrecht.nl.|Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center, PO Box 85500, 3508 GA, Utrecht, The Netherlands. r.debree@umcutrecht.nl.
authors.forename: Remco
authors.initials: R
authors.lastname: de Bree
mesh_terms: D006801:Humans; D061305:Lymphoscintigraphy; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D015899:Tomography, Emission-Computed, Single-Photon
keywords: Lymphatic metastasis; Lymphoscintigraphy; Oral cancer; Sentinel lymph nodes; Single-photon emission computed tomography