Clinical articlesMultimodal image registration for localization of sentinel nodes in head and neck squamous cell carcinoma
Section snippets
Patients
All patients were treated in the Department of Maxillofacial and Plastic Surgery, Purpan University Hospital, Toulouse, France, between August 2002 and August 2003. The clinical series included 10 patients with N0 oral cancer (8 men and 2 women; age range, 42 to 67 years; mean age, 55.5 ± 7.8 years). Clinical examination and systematic preoperative CT scan did not detect any suspicious cervical lymph nodes. Five patients (50%) had a unilateral tumor (gingivae, oral tongue, lateral floor of the
Planar lymphoscintigraphy
In our study, the sensitivity of PLS was 100%; that is, the camera preoperatively detected at least 1 SN in all our patients. In all cases of midline tumors, PLS revealed at least 1 right and 1 left cervical SN.
Image registration
Although the sensitivity of PLS is 100%, multimodal image registration localized the SN in only 9 of 10 cases. This shows the limits of image registration, but it also shows the value of intraoperative use of the hand-held gamma probe, which enabled us to identify and resect the SN
Discussion
Of the various radiotracers that are available for lymphoscintigraphy, only 99mTc-sulfur colloid (99mTc-SC) Nanocis (CIS Bio International) and 99mTc-albumin colloid (99mTc-CA) (Nanocoll; GE Healthcare, London, United Kingdom) are obtainable in Europe and have been approved for medical use. Nanocis and Nanocoll represent the properties of the ideal radiotracer, 19, 20, 21 with rapid, predictable flow and durable uptake in the SN.
In our study, the sensitivity of PLS was 100%; that is, in all
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Gamma camera imaging of sentinel lymph nodes in early stage oral cancer
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2011, Seminars in OncologyCitation Excerpt :Multiple drainage basins have been described in up to 33% of patients and can change the extent of surgery indicated.86 Three other studies in 61 patients have shown similar results using SPECT/CT.87-89 In cutaneous melanoma, small series with SPECT/CT imaging have reported benefits such as precise localization, change in surgical approach, additional SLN visualized, and multiple drainage basins in up to 50% of patients.79,86
Oral Squamous Cell Carcinoma: Treatment
2011, Current Therapy in Oral and Maxillofacial SurgeryHybrid Imaging by SPECT/CT and PET/CT: Proven Outcomes in Cancer Imaging
2009, Seminars in Nuclear MedicineCitation Excerpt :An overlay with CT therefore helps considerably in preoperative SLN localization. This has been helpful in a variety of clinical settings and types of cancer, including breast carcinoma, malignant melanoma, and tumors draining into the pelvis or neck.92-111 In particular, hybrid imaging was of special importance in obese patients with breast cancer: it correctly localized SLNs in 75% of patients in whom blue dye failed, and it identified false-positive findings in 20 of 317 hot nodes detected by planar imaging in a prospective study of 220 patients.109