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Lymphoscintigraphy after the peritumoral injection. For 1 hr after the injection, dynamic lymphoscintigraphy was performed every 5 min in the anterior and lateral views and then until 2 hr prior to surgery at an interval of 3-6 hr, with static images obtained to monitor the residual radioactivity.
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The objective of this study was to evaluate the feasibility of sentinel lymph node biopsy by using a radiotracer lymphatic mapping technique in patients with squamous cell carcinoma of the oral cavity, and the diagnostic value of this technique. We studied twenty patients with previously untreated squamous cell carcinomas of the oral cavity and N0...
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Lymphoscintigraphy with 99mTc-antimony sulphide colloid was performed on patients with cutaneous melanoma of the back to define draining node fields and sentinel nodes before surgery.
One patient was found to have drainage from the back to sentinel lymph nodes in the triangular intermuscular spaces bilaterally, above and lateral to the scapula. Sub...
Citations
... Several authors 8 have shown that the incidence of lymphatic metastases is less than 5% in head and neck squamous cell carcinoma if there are no histological findings in SLN. Therefore, SLN mapping is becoming a technique of growing interest in OCSCC, in particular in early stages 9 . Near-Infrared fluorescence (NIR) endoscopy with indocyanine green (ICG) enables real-time intraoperative imaging of the lymphatic tissue with high spatial resolution 10,11 . ...
OBJECTIVE: Near-Infrared (NIR) fluorescence imaging is a novel technique for intraoperative sentinel lymph node (SLN) identification. It has demonstrated promising results in several surgical specialties. The study aims to evaluate the feasibility of identifying the SLN by indocyanine green (ICG) enhanced NIR endoscopy in squamous cell carcinoma of the oral cavity (OCSCC).
PATIENTS AND METHODS: Seven patients with (cT1-3 N0) OCSCC were included. We injected 1-1.25 ml of ICG (5 mg/ml) at four to five points around the primary. After the elevation of a platysma flap and posterior retraction of the sternocleidomastoid muscle, fluorescence images were taken via IMAGE1 STM NIR/ICG system to define the SLN(s). We sampled fluorescence marked SLN(s) stratified to lymph node levels, followed by level-specified elective neck dissection.
RESULTS: The detection of at least one unilateral or bilateral SLN (range 1-5) was possible in every case. The fluorescence signal occurred, on average, 5.0 ± 2.2 minutes after injection. A total of 22 SLN could be identified. Among 331 histologically examined lymph nodes we could detect one micrometastasis, which was correctly defined as SLN (1/22). There were no false-negative findings. No adverse reactions to ICG occurred.
CONCLUSIONS: Our first results are indicating the concept of SLN concerning OCSCC after the application of real-time NIR fluorescence endoscopy. However, this has to be verified by more extended studies.
... Several authors have shown that the incidence of lymphatic metastases is less than 5% in head and neck squamous cell carcinoma if there are no histological findings in SLN [8]. Therefore SLN mapping is becoming a technique of growing interest in OCSCC, in particular in early stages [9]. Near-Infrared fluorescence (NIR) endoscopy with indocyanine green (ICG) enables real-time intraoperative imaging of the lymphatic tissue with high spatial resolution [10,11]. ...
Background
Near-Infrared (NIR) fluorescence imaging is a novel technique for intraoperative sentinel lymph node (SLN) identification. It has demonstrated promising results in several surgical specialties. The study aims to evaluate the feasibility of identifying the SLN by indocyanine green (ICG) enhanced NIR endoscopy in squamous cell carcinoma of the oral cavity (OCSCC).
Methods
Five patients with (cT1-3N0) OCSCC were included. We injected 1–1.25 ml of ICG (5 mg/ml) at four to five points around the primary. After the elevation of a platysma flap and posterior retraction of the sternocleidomastoid muscle, fluorescence images were taken with the IMAGE1 S™ NIR/ICG system to define the SLN(s). We sampled fluorescence marked SLN(s) stratified to lymph node levels, followed by level-specified elective neck dissection.
Results
The detection of at least one uni- or bilateral SLN (range 1–4) was possible in every case. The fluorescence signal occurred, on average, 4.8 ± 2.6 minutes after injection. There was no case of neck metastasis in SLN (0/13) and non-SLN (0/189). No adverse reactions to ICG occurred.
Conclusions
Our first results are confirming the concept of SLN concerning OCSCC after the application of real-time NIR fluorescence endoscopy. However, this has to be verified by more extended studies.
... In nuclear medicine and intra-operative imaging the objects under investigation have certain spatial dimensions [8]. For example, the lymph nodes can be considered as spheres with diameter around 1 to 2 cm [9], [10]. Therefore, different geometrical configurations of the coded aperture γ-camera can be used for the imaging of the sentinel lymphs, or the thyroid residue, in order to achieve the best SNR possible. ...
Using coded aperture, for localization of radioactive hot-spots, results in enhanced efficiency and under certain configurations wide Field of View (FOV).We present a coded aperture assembly technique which can be restructured easily, as well as the reduction of the intrinsic noise of coded apertures constructed with this technique, when they localize spatially extended -emitters.
Specifically, Modified-Uniformly-Redundant-Array (MURA) coded apertures are structured by embedding lead spheres in a matrix of positions machined inside a transparent medium such as
acrylic glass, resulting in an advantageous transparent to opaque area ratio and thus an improved detection efficiency. This configuration also induces a systematic, element-wise, noise on the Point-
Spread-Function (PSF) of the correlation matrix. When imaging with these apertures extended hot-spots, a penumbra phenomenon occurrs and reduces this intrinsic noise, in the way a kernel filter does. Fast-Fourier-Transform (FFT) is used to analyze the effect of this phenomenon on the correlation matrix and to explain the maximization of its Signal-to-Noise Ratio (SNR) for certain extent of the hot-spots. Simulations have been used for the detailed study of the SNR dependence on the dimensions of the hot-spot, while experiments with two 99mTc cylindrical sources with 11mm and 24mm diameter, respectively and 1.5MBq activity each, confirm the reduction of the intrinsic noise. The results define the way of optimization of the imaging setup for the detection of extended hot-spots. Such an optimization could be useful for example in the case of lymph nodes or thyroid remnant imaging in nuclear medicine. Finally, we propose a kernel filter, derived by the Auto-Correlation-Function (ACF), to be applied on PSFs with high intrinsic noise, in order to
eliminate it.
... In nuclear medicine and intra-operative imaging the objects under investigation have certain spatial dimensions [8]. For example, the lymph nodes can be considered as spheres with diameter around 1 to 2 cm [9], [10]. Therefore, different geometrical configurations of the coded aperture γ-camera can be used for the imaging of the sentinel lymphs, or the thyroid residue, in order to achieve the best SNR possible. ...
Using coded aperture, for localization of radioactive hot-spots, results in enhanced efficiency and under certain configurations wide Field of View (FOV). We present a coded aperture assembly technique which can be restructured easily, as well as the reduction of the intrinsic noise of coded apertures constructed with this technique, when they localize spatially extended {\gamma}-emitters. Specifically, Modified-Uniformly-Redundant-Array (MURA) coded apertures are structured by embedding lead spheres in a matrix of positions machined inside a transparent medium such as acrylic glass, resulting in an advantageous transparent to opaque area ratio and thus an improved detection efficiency. This configuration also induces a systematic, element-wise, noise on the Point-Spread-Function (PSF) of the correlation matrix. When imaging with these apertures extended hot-spots, a penumbra phenomenon occurrs and reduces this intrinsic noise, in the way a kernel filter does. Fast-Fourier-Transform (FFT) is used to analyze the effect of this phenomenon on the correlation matrix and to explain the maximization of its Signal-to-Noise Ratio (SNR) for certain extent of the hot-spots. Simulations have been used for the detailed study of the SNR dependence on the dimensions of the hot-spot, while experiments with two 99mTc cylindrical sources with 11mm and 24mm diameter, respectively and 1.5 MBq activity each, confirm the reduction of the intrinsic noise. The results define the way of optimization of the imaging setup for the detection of extended hot-spots. Such an optimization could be useful for example in the case of lymph nodes or thyroid remnant imaging in nuclear medicine. Finally, we propose a kernel filter, derived by the Auto-Correlation-Function (ACF), to be applied on PSFs with high intrinsic noise, in order to eliminate it.
... In terms of the types of neck dissections, sentinel node biopsy (SNB) was performed in 60 patients (36.1%) and END was performed in 106 patients (63.9%), as described previously. 20 The END encompassed levels I, II, and III in 86 patients (81.1%), and expanded to level IV or V in 20 patients (18.9%). ...
Background:
The purpose of this study was to investigate whether adjuvant radiotherapy (RT) is efficacious for regional control and survival in patients with pN0 oral tongue cancer.
Methods:
Clinicopathological features of 166 patients with pN0 oral tongue cancer were compared between those who underwent adjuvant RT to the neck (neck RT-positive) and those who did not (neck RT-negative). Study endpoints were isolated regional recurrence and 3-year regional recurrence-free survival (RRFS). Propensity score matching was also performed.
Results:
Cox regression analysis did not reveal any significant predictor of isolated regional recurrence, including RT field. Three-year RRFS showed modest improvement in neck RT-positive group compared to neck RT-negative group before (92.2% vs 91.9%) and after propensity analysis (93.8% vs 83.3%), without statistical significance (log-rank P = .85 and .37, respectively).
Conclusion:
Despite more frequent unfavorable factors, the neck RT-positive group had a comparable oncologic outcome to the neck RT-negative group, suggesting that a marginal benefit in regional control might be expected from extending the RT field to the neck for pN0 oral tongue cancer.
... Additional non-SLN metastases were mainly found in levels I, II, and III and sometimes in level IV or V [7,13,15,16,21,22]. The pooled prevalence of non-SLN metastasis in patients with positive SLN(s) of this study and 26 other studies [6,7,[11][12][13][14][15][16][17][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] was 31 % (156/511). ...
... Including our results, a higher pooled prevalence for additional non-SLN metastases had been found when [1 positive SLNs were present (29 vs. 24 %) [11,13,16,[22][23][24]30], the absence of negative SLNs (40 vs. 19 %) [13, 15, 16, 22-24, 30, 33, 37], and in the case of a positive SLN ratio of more than 50 % (38 vs. 19 %) [13, 16, 22-24, 30, 33]. Results are shown in Table 3. SLNB sentinel lymph node biopsy, SLNs sentinel lymph nodes Taylor [24] 0 % (0/4) ...
To determine risk factors for additional non-sentinel lymph node metastases in neck dissection specimens of patients with early stage oral cancer and a positive sentinel lymph node biopsy (SLNB). A retrospective analysis of 36 previously untreated SLNB positive patients in our institution and investigation of currently available literature of positive SLNB patients in early stage oral cancer was done. Degree of metastatic involvement [classified as isolated tumor cells (ITC), micro- and macrometastasis] of the sentinel lymph node (SLN), the status of other SLNs, and additional non-SLN metastases in neck dissection specimens were analyzed. Of 27 studies, comprising 511 patients with positive SLNs, the pooled prevalence of non-SLN metastasis in patients with positive SLNs was 31 %. Non-SLN metastases were detected (available from 9 studies) in 13, 20, and 40 % of patients with ITC, micro-, and macrometastasis in the SLN, respectively. The probability of non-SLN metastasis seems to be higher in the case of more than one positive SLN (29 vs. 24 %), the absence of negative SLNs (40 vs. 19 %), and a positive SLN ratio of more than 50 % (38 vs. 19 %). Additional non-SLN metastases were found in 31 % of neck dissections following positive SLNB. The presence of multiple positive SLNs, the absence of negative SLNs, and a positive SLN ratio of more than 50 % may be predictive factors for non-SLN metastases. Classification of SLNs into ITC, micro-, and macrometastasis in the future SLNB studies is important to answer the question if treatment of the neck is always needed after positive SLNB.
... Several surgeons transact intra-operative procedures for localizing 99m Tc-traced cancerous tissues assisted by gamma counter probes or small mobile gamma cameras. The actual size of sentinel nodes and thyroid remnants traced with radio-isotope is from a few millimeters up to 2 cm in diameter [1,2]. Considering, also, the anatomy of these tissues, they are spaced apart more than 2 cm. ...
Coded aperture imaging transcends planar imaging with conventional collimators in efficiency and Field of View (FOV). We present experimental results for the detection of 141 keV and 122 keV γ-photons emitted by uniformly extended 99mTc and 57Co hot-spots along with simulations of uniformly and normally extended 99mTc hot-spots. These results prove that the method can be used for intra-operative imaging of radio-traced sentinel nodes and thyroid remnants. The study is performed using a setup of two gamma cameras, each consisting of a coded-aperture (or mask) of Modified Uniformly Redundant Array (MURA) of rank 19 positioned on top of a CdTe detector. The detector pixel pitch is 350 μm and its active area is 4.4 × 4.4 cm2, while the mask element size is 1.7 mm. The detectable photon energy ranges from 15 keV up to 200 keV with an energy resolution of 3–4 keV FWHM. Triangulation is exploited to estimate the 3D spatial coordinates of the radioactive spots within the system FOV. Two extended sources, with uniform distributed activity (11 and 24 mm in diameter, respectively), positioned at 16 cm from the system and with 3 cm distance between their centers, can be resolved and localized with accuracy better than 5%. The results indicate that the estimated positions of spatially extended sources lay within their volume size and that neighboring sources, even with a low level of radioactivity, such as 30 MBq, can be clearly distinguished with an acquisition time about 3 seconds.
... Cervical lymph node status is important for operation method and prognosis. Broglie et al. [2] 2013 110 Switzerland 42 0 3 65 0.93 1.00 Melkane et al. [3] 2012 53 U.S 12 0 0 41 1.00 1.00 Pezier et al. [4] 2012 57 England 17 0 1 39 0.94 1.00 Vorburger et al. [5] 2012 92 Switzerland 34 0 3 55 0.92 1.00 Alkureishi et al. [6] 2010 53 England 22 0 1 30 0.96 1.00 Burcia et al. [7] 2010 40 France 18 0 0 32 1.00 1.00 Burns et al. [8] 2009 12 Ireland 4 0 0 8 1.00 1.00 Li and Liao [9] 2008 19 China 4 0 6 9 0.4 1.00 Stoeckli [10] 2007 28 Switzerland 9 0 0 19 1.00 1.00 Jeong et al. [11] 2006 20 Korea 6 0 0 14 1.00 1.00 Civantos et al. [12] 2006 140 U.S 37 0 4 99 0.9 1.00 Hart et al. [13] 2005 14 Canada 2 0 0 12 1.00 1.00 Rigual et al. [14] 2005 20 U.S 10 0 2 8 0.83 1.00 Höft et al. [15] 2004 29 Germany 10 0 0 19 1.00 1.00 Kontio et al. [16] 2004 14 Finland 2 0 1 11 0.67 1.00 Ross et al. [17] 2004 61 England 25 0 2 34 0.93 1.00 Hyde et al. [18] 2003 17 England 3 0 1 13 0.75 1.00 Pitman et al. [19] 2002 13 U.S 2 0 0 11 1.00 1.00 Barzan et al. [20] 2002 11 Italy 3 0 1 7 0.75 1.00 Pastore et al. [21] 2002 20 Italy Previously, studies have discussed the clinical predictive value of cervical lymph node metastasis through SLNB in patients with oral cancer. [11][12][13][14] However, the number of patients included in each study was relatively small, and the statistical power is relative low. ...
... Broglie et al. [2] 2013 110 Switzerland 42 0 3 65 0.93 1.00 Melkane et al. [3] 2012 53 U.S 12 0 0 41 1.00 1.00 Pezier et al. [4] 2012 57 England 17 0 1 39 0.94 1.00 Vorburger et al. [5] 2012 92 Switzerland 34 0 3 55 0.92 1.00 Alkureishi et al. [6] 2010 53 England 22 0 1 30 0.96 1.00 Burcia et al. [7] 2010 40 France 18 0 0 32 1.00 1.00 Burns et al. [8] 2009 12 Ireland 4 0 0 8 1.00 1.00 Li and Liao [9] 2008 19 China 4 0 6 9 0.4 1.00 Stoeckli [10] 2007 28 Switzerland 9 0 0 19 1.00 1.00 Jeong et al. [11] 2006 20 Korea 6 0 0 14 1.00 1.00 Civantos et al. [12] 2006 140 U.S 37 0 4 99 0.9 1.00 Hart et al. [13] 2005 14 Canada 2 0 0 12 1.00 1.00 Rigual et al. [14] 2005 20 U.S 10 0 2 8 0.83 1.00 Höft et al. [15] 2004 29 Germany 10 0 0 19 1.00 1.00 Kontio et al. [16] 2004 14 Finland 2 0 1 11 0.67 1.00 Ross et al. [17] 2004 61 England 25 0 2 34 0.93 1.00 Hyde et al. [18] 2003 17 England 3 0 1 13 0.75 1.00 Pitman et al. [19] 2002 13 U.S 2 0 0 11 1.00 1.00 Barzan et al. [20] 2002 11 Italy 3 0 1 7 0.75 1.00 Pastore et al. [21] 2002 20 Italy Previously, studies have discussed the clinical predictive value of cervical lymph node metastasis through SLNB in patients with oral cancer. [11][12][13][14] However, the number of patients included in each study was relatively small, and the statistical power is relative low. Hence, the clinical evidence for predictive value of cervical lymph node metastasis through SLNB in patients with oral cancer was not strong enough. ...
Objective: The purpose of this meta-analysis was to evaluate the predictive value of cervical lymph node metastasis through sentinel lymph node biopsy (SLNB) in patients with oral cancer.
Materials and Methods: Two authors independently searched the databases of PubMed, Cochrane central register of controlled trials, EMBASE, and CNKI to find the potential suitable diagnostic study related to SLNB. The diagnostic sensitivity, specificity, positive likely hood ratio (+LR), negative likely hood ratio (–LR), diagnostic odds ratio (DOR) were pooled by Meta-DiSc1.4 software. The publication bias was assessed by funnel plot and line regression test.
Results: After electronic searching the related databases, we finally included twenty diagnostic studies. The pooled sensitivity, specificity, +LR, and DOR were 0.91 (95% confidence interval [CI]: 0.88–0.94), 1.00 (95% CI: 0.99–1.00), 35.52 (95% CI: 19.19–65.75), and 323.50 (95% CI: 148.27–705.83), respectively, with fixed-effect model. Moreover, the pooled –LR was 0.13 (95% CI: 0.07–0.23) by random-effect model. The area under the summary receiver operating characteristic curve of SLNB for cervical lymph node metastasis was 0.99.
Conclusion: SLNB had very high sensitivity and specificity for productizing cervical lymph node metastasis in oral cancer patients.
... There is still some debate in the literature regarding the accuracy of SNB for floor of mouth tumors compared to other oral locations. [38][39][40] The argument by those who report a lower sensitivity and negative predictive value for floor of mouth tumors compared to other locations is that tumors in the floor of mouth lie in very close proximity to level I nodes leading to difficulty in identifying and harvesting SLNs. [14,40] Antonio et al. [2] state that the minimum treatment of the neck is probably dissection of the levels between the primary tumour and the level containing the SN(s). ...
Aim: The purpose of this study was to conduct a systematic review of the published literature to assess the state of the art of this procedure. Sentinel node biopsy (SNB) in oral squamous cell cancer (OSCC) is a novel and proven useful technique alternative to the neck dissection (ND) in the management of OSCC.
Methods: The authors searched PubMed for literature in English published for the last five years, addressing this topic. Prospective studies articles were selected with at least thirty patients studied.
Results: Of 235 studies found, 14 studies met the exclusion and inclusion criteria for this review. The studies selected focused on the role of the SNB in the OSCC, advantages compared to ND and its limitations, testing different solutions and innovations that could implement the conventional procedure. Meta-analysis studies and review articles were also selected in order to perform the introduction and support the discussion. Based upon these findings authors have tried to establish the state of the art of the SNB and authors have highlighted recent advances that improve the sentinel lymphatic node biopsy technique in the future.
Conclusion: SNB is an excellent staging method in OSCC and an interesting alternative to ND. The authors show the most appropriate procedures recommended in the bibliography revised in a trend to depict the actual state of the art.
... A selective ipsilateral neck dissection routinely done in many institutions in such circumstances allows for histopathological evaluation of neck disease and usually caries low morbidity. However, up to 70% of patients undergo a selective ND with no evident disease [8], which raises the question as whether innovative techniques such as SLNB can improve this unsatisfactory situation Although the intraoperative detection rate of the acoustic gamma probe for SLNB in HNSCC is claimed to be almost 100% and the false-negative rate is generally believed to be below 5% [12,13], some groups reported false-negative rates up to 12% [14,15] and also had difficulties detecting SLNs. ...
Conclusion:
Feasibility of intraoperative 3D imaging with freehand (fh) SPECT for sentinel lymph node (SLN) biopsy in head and neck cancer (HNC) could be demonstrated. Controlled clinical studies are needed to evaluate its accuracy and impact on patient morbidity.
Objectives:
The clinical N0 neck in HNC needs improvement in management to sufficiently detect occult neck disease but to spare patients from potential morbidity by elective neck dissection. The SLN concept has potential to accurately stage the neck with low morbidity.
Methods:
fhSPECT is a 3D tomographic imaging modality with a gamma probe system combined with an infrared optical tracking system. Five patients with HNC and clinical N0 neck were recruited. Scanning for SLN using fhSPECT was performed before excision and selective neck dissection and specimens were analyzed histopathologically.
Results:
Preoperatively, a total of nine SLNs were located in five patients with fhSPECT. SLNs in three patients were positive for metastatic disease; in two patients the SLNs were tumor-free. No residual radioactivity was found in the neck in any of the patients after extirpation of SLNs. fhSPECT acquisitions took 2.6 ± 0.4 min. No metastatic lymph nodes were detected in any other node harvested during subsequent selective neck dissection in any patients.
