Sentinel node in oral cancer: the nuclear medicine aspects. A survey from the sentinel european node trial

Girolamo Tartaglione , Sandro Stoeckli , Remco de Bree , Clare Schilling (1) , Geke Flach , Vivi Bakholdt , Jens Ahm Sorensen (2) , Anders Bilde , Christian von Buchwald (3) , Georges Lawson (4) , Didier Dequanter , Pedro Villarreal (5) , Manuel Florentino Fresno Forcelledo , Julio Alvarez Amezaga , Augusto Moreira (6) , Tito Poli , Cesare Grandi (7) , Maurizio Giovanni Vigili , Michael O'Doherty , Davide Donner , Elisabeth Bloemena , Siavash Rahimi (8) , Benjamin Gurney , Stephan Haerle , Martina Broglie , Gerhard Huber , Annelise Krogdah , Lars R Sebbesen , Edward Odell , Luis Manuel Junquera Gutierrez , Luis Barbier (9) , Joseba Santamara-Zuazua , Manuel Jacome (10) , Marie-Cécile Nollevaux , Emma Bragantini , Philippe Lothaire , Enrico Silini , Enrico Sesenna , Gilles Dolivet (11) , Romina Mastronicola (11) , Agnès Leroux (11) , Isabel Sassoon , Philip Sloan , Patrick Colletti , Domenico Rubello (12) , Mark Mcgurk

1 University of Freiburg [Freiburg]
2 UMN - University of Minnesota [Twin Cities]
3 Department of Otorhinolaryngology
4 McDonald Institute of Archaeological Research
5 IMAFF
6 CITI - Centro de Informática e Tecnologia Informação
7 INFN, Sezione di Bologna - Istituto Nazionale di Fisica Nucleare, Sezione di Bologna
8 Department of Environmental Health Engineering and Research Center for Health Science
9 PErSEUs - Psychologie Ergonomique et Sociale pour l'Expérience utilisateurs
10 ECE - Department of Electrical and Computer Engineering - University of Texas
11 CRAN - Centre de Recherche en Automatique de Nancy
12 Department of Nuclear Medicine

Nuclear imaging plays a crucial role in lymphatic mapping of oral cancer. This evaluation represents a subanalysis of the original multicenter SENT trial data set, involving 434 patients with T1-T2, N0, and M0 oral squamous cell carcinoma. The impact of acquisition techniques, tracer injection timing relative to surgery, and causes of false-negative rate were assessed. Three to 24 hours before surgery, all patients received a dose of Tc-nanocolloid (10-175 MBq), followed by lymphoscintigraphy. According to institutional protocols, all patients underwent preoperative dynamic/static scan and/or SPECT/CT. Lymphoscintigraphy identified 723 lymphatic basins. 1398 sentinel lymph nodes (SNs) were biopsied (3.2 SN per patient; range, 1-10). Dynamic scan allowed the differentiation of sentinel nodes from second tier lymph nodes. SPECT/CT allowed more accurate anatomical localization and estimated SN depth more efficiently. After pathological examination, 9.9% of the SN excised (138 of 1398 SNs) showed metastases. The first neck level (NL) containing SN+ was NL I in 28.6%, NL IIa in 44.8%, NL IIb in 2.8%, NL III in 17.1%, and NL IV in 6.7% of positive patients. Approximately 96% of positive SNs were localized in the first and second lymphatic basin visualized using lymphoscintigraphy. After neck dissection, the SN+ was the only lymph node containing metastasis in approximately 80% of patients. Best results were observed using a dynamic scan in combination with SPECT/CT. A shorter interval between tracer injection, imaging, and surgery resulted in a lower false-negative rate. At least 2 NLs have to be harvested, as this may increase the detection of lymphatic metastases.

Domaines: Automatique / Robotique

Girolamo Tartaglione, Sandro Stoeckli, Remco de Bree, Clare Schilling, Geke Flach, et al.. Sentinel node in oral cancer: the nuclear medicine aspects. A survey from the sentinel european node trial. Clinical Nuclear Medicine, 2016, 41 (7), pp.534-542. ⟨10.1097/RLU.0000000000001241⟩. ⟨hal-01323638⟩