DOI: 10.1007/s00259-017-3613-8Pages: 1-7

The added value of SPECT-CT for the identification of sentinel lymph nodes in early stage oral cancer

1. VU University Medical Center, Department of Otolaryngology-Head and Neck Surgery

2. UMC Utrecht Cancer Center, University Medical Center, Department of Head and Neck Surgical Oncology

3. VU University Medical Center, Department of Radiology and Nuclear Medicine

4. VU University Medical Center/Academic Centre for Dentistry (ACTA) Amsterdam, Department of Oral and Maxillofacial Surgery/Oral Pathology

5. VU University Medical Center, Department of Pathology

Correspondence to:
Remco Bree
Email: r.debree@umcutrecht.nl

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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 two 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 four 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.

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  • Accepted: Jan 2, 2017
  • Online: Jan 29, 2017

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