Page 128 - Sentinel lymph node biopsy in oral cavity cancer - Inne J. den Toom

Chapter 7 ABSTRACT Purpose 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 2 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 4 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. 126