Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Ann Nucl Med. 2021 Dec;35(12):1353-1360. doi: 10.1007/s12149-021-01677-6. Epub 2021 Sep 13.
Sentinel lymph-node (SLN) mapping for early-stage oral squamous cell carcinoma (OSCC) is comprehensive and consequently time-consuming and costly. This study evaluated the clinical value of several SLN imaging components and analyzed the accuracy for SLN identification using a streamlined SLN imaging protocol in early-stage OSCC.
This retrospective within-patient evaluation study compared both number and localization of identified SLNs between the conventional SLN imaging protocol and a streamlined imaging protocol (dynamic lymphoscintigraphy (LSG) for 10 min directly post-injection and SPECT-CT at ~ 2 h post-injection). LSG and SPECT-CT images of 77 early-stage OSCC patients, scheduled for SLN biopsy, were evaluated by three observers. Identified SLNs using either protocol were related to histopathological assessment of harvested SLNs, complementary neck dissection specimens and follow-up status.
A total of 200 SLNs were identified using the streamlined protocol, and 12 additional SLNs (n = 212) were identified with the conventional protocol in 10 patients. Of those, 9/12 were identified on early static LSG and 3/12 on late static LSG. None of the additionally identified SLNs contained metastases; none of those in whom additional SLNs were identified developed regional recurrence during follow-up. Only inferior alveolar process carcinoma showed a higher rate of additionally identified SLNs with the conventional protocol (p = 0.006).
Early dynamic LSG can be reduced to 10 min. Late static LSG may be omitted, except in those with a history of oncological neck treatment or with OSCC featuring slow lymphatic drainage. Early static LSG appeared to be contributory in most OSCC subsites.
早期口腔鳞状细胞癌（OSCC）的前哨淋巴结（SLN）定位是全面的，因此耗时且昂贵。本研究评估了几种 SLN 成像成分的临床价值，并分析了在早期 OSCC 中使用简化 SLN 成像方案对 SLN 识别的准确性。
这项回顾性的患者内评估研究比较了传统 SLN 成像方案和简化成像方案（注射后 10 分钟直接进行动态淋巴闪烁成像（LSG）和注射后约 2 小时进行 SPECT-CT）之间识别的 SLN 的数量和定位。对计划进行 SLN 活检的 77 例早期 OSCC 患者的 LSG 和 SPECT-CT 图像由三位观察者进行评估。使用任一方案识别的 SLN 与经活检的 SLN、补充的颈部解剖标本和随访情况的组织病理学评估相关。
使用简化方案共识别出 200 个 SLN，10 例患者的传统方案额外识别出 12 个 SLN（n=212）。其中，9/12 个是在早期静态 LSG 上识别出的，3/12 个是在晚期静态 LSG 上识别出的。额外识别出的 SLN 均未发现转移；在随访期间，识别出额外 SLN 的患者均未发生区域性复发。只有下牙槽突癌的传统方案识别出更多的额外 SLN（p=0.006）。
早期动态 LSG 可以缩短至 10 分钟。晚期静态 LSG 可以省略，除非患者有肿瘤颈部治疗史或 OSCC 有缓慢的淋巴引流。早期静态 LSG 似乎对大多数 OSCC 亚部位都有帮助。
