Thomas Carissa M, Khan Mohemmed N, Mohan Ravi, Hendler Aaron, Hosni Ali, Chepeha Douglas B, Goldstein David P, Cooper Richard M, de Almeida John R
Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
Head Neck. 2020 Mar;42(3):385-393. doi: 10.1002/hed.26011. Epub 2019 Nov 28.
Risk of contralateral nodal metastases in oropharyngeal squamous cell carcinoma (OPSCC) is currently based on clinical risk factors. We propose lymphatic mapping with single photon emission computed tomography (SPECT-CT) for tumor-specific delineation of lymphatic drainage to guide treatment.
Retrospective review of lymphatic drainage patterns in cT1-2 OPSCC and contralateral cN0 neck with a nonoperative, awake injection of 99 m-Tc sulfur colloid and SPECT-CT.
Ten patients were reviewed. Primary sites included tonsil (n = 8, 80%) and tongue base (n = 2, 20%). All patients tolerated awake injections with no complications. Nine patients (90%) demonstrated satisfactory migration of radiotracer to neck node(s) with seven (78%) to the ipsilateral lateral neck, one (11%) to the ipsilateral lateral neck and retropharynx, and one (11%) to bilateral lateral neck nodes.
Characterization of lymphatic drainage in OPSCC is feasible using a nonoperative injection technique and SPECT-CT. Drainage to the contralateral neck is rare, warranting further study to tailor treatment appropriately.
口咽鳞状细胞癌（OPSCC）对侧淋巴结转移风险目前基于临床风险因素。我们建议采用单光子发射计算机断层扫描（SPECT-CT）进行淋巴绘图，以实现肿瘤特异性淋巴引流描绘，从而指导治疗。
对cT1-2期OPSCC且对侧颈部cN0的患者，在非手术清醒状态下注射99m锝硫胶体并进行SPECT-CT，回顾性分析其淋巴引流模式。
共纳入10例患者进行回顾。原发部位包括扁桃体（n = 8，80%）和舌根（n = 2，20%）。所有患者均耐受清醒状态下的注射，无并发症发生。9例患者（90%）示踪剂向颈部淋巴结迁移良好，其中7例（78%）迁移至同侧颈部外侧，1例（11%）迁移至同侧颈部外侧及咽后，1例（11%）迁移至双侧颈部外侧淋巴结。
采用非手术注射技术及SPECT-CT描绘OPSCC淋巴引流是可行的。向对侧颈部的引流罕见，需要进一步研究以合理调整治疗方案。
