PurposeSentinel lymph node biopsy is an essential staging tool in patients with clinically localized oral cavity squamous cell carcinoma. The harvesting of a sentinel lymph node entails a sequence of procedures with participation of specialists in nuclear medicine, radiology, surgery, and pathology. The aim of this document is to provide guidelines for nuclear medicine physicians performing lymphoscintigraphy for sentinel lymph node detection in patients with early N0 oral cavity squamous cell carcinoma.MethodsThese practice guidelines were written and have been approved by the European Association of Nuclear Medicine (EANM) and the International Atomic Energy Agency (IAEA) to promote high-quality lymphoscintigraphy. The final result has been discussed by distinguished experts from the EANM Oncology Committee, and national nuclear medicine societies. The document has been endorsed by the Society of Nuclear Medicine and Molecular Imaging (SNMMI).These guidelines, together with another two focused on Surgery and Pathology (and published in specialised journals), are part of the synergistic efforts developed in preparation for the “2018 Sentinel Node Biopsy in Head and Neck Consensus Conference”.ConclusionThe present practice guidelines will help nuclear medicine practitioners play their essential role in providing high-quality lymphatic mapping for the care of early N0 oral cavity squamous cell carcinoma patients.

UK national guidelines in 2016 recommended that sentinel lymph node biopsy should be offered to patients with early oral cancer (T1-T2 N0) in which the primary site can be reconstructed directly. This study describes the pitfalls that can be avoided in the technique of biopsy to improve outcomes. We retrospectively analysed the data from 100 consecutive patients and recorded any adverse events. Lymphatic drainage of tracer failed in two patients as a result of procedural errors. Two patients with invaded nodes developed recurrence after total neck dissection, one after micrometastases had been diagnosed, and the other as a result of extranodal spread that had led to understaging and therefore undertreatment. Two results would not have been mistakenly classified as clear if all the harvested nodes had been analysed histologically according to the protocol. The disease-specific (96%) and disease-free (92%) survival were better than expected for a group of whom a third had stage 3 disease. If all harvested nodes had been analysed by the correct protocol then two of the three nodes wrongly designated clear would have been detected, two deaths potentially avoided, and the false-negative rate would have fallen from 8.3% to 2.7%. We conclude that minor deviations from protocol can result in a detrimental outcome for the patient.

At the present time, there is a dilemma concerning the best management of the neck in patients presenting with early head and neck squamous cell carcinoma (HNSCC). Occult cervical metastasis is found in up to a quarter of HNSCC patients with radiologically N0 necks, and for this reason, conventional treatment includes elective neck dissection (END) alongside tumour excision. Sentinel node biopsy (SNB) offers an alternative accurate and minimally invasive method of staging the neck, which has been safely applied to oral cancer. SNB is a patientspecific procedure which has an enhanced recovery compared to END but is currently not widely offered to patients. There are exciting developments in the technology supporting SNB, improving the accuracy and ease of the procedure and opening up the technique to new tumour types. We describe our experiences in using a novel intraoperative navigation device for sentinel node retrieval and review other advances in SNB practice which have the potential to change the standard management for patients with early HNSCC.Keywords Sentinel node biopsy Á Freehand SPECT Á Head and neck squamous cell carcinoma Á Cervical metastasis Á Guided intraoperative scintigraphic tumour targeting (GOSTT)

No abstract

No abstract