New Developments in Sentinel Lymph Node Biopsy Procedure in Localized Oral Cancer

Bree, Remco de; Dankbaar, Jan Willem; Keizer, Bart de

doi:10.1001/jamaoto.2019.1342

Cited by 3 publications

(5 citation statements)

References 8 publications

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“…Moreover, the high spatial resolution of MR lymphography eliminates the shine-through phenomenon, allowing identification of SLNs in vicinity of the tracer injection site. Additionally, MR lymphography is free of radiation exposure and does not require radioisotopes, which is of particular benefit if specific nuclear medicine facilities are unavailable [ 89 , 90 ].…”

Section: Discussionmentioning

confidence: 99%

“…A proposed alternative for intraoperative localization of SLNs is fluorescence guided surgery following peritumoral injection of ICG [ 92 , 93 ]. However, due to limited tissue penetration of the fluorescent signal and rapid flow through lymphatics of unbound ICG, matching of preoperative depicted SLNs and intraoperative fluorescent lymph nodes is challenging [ 90 ].…”

Section: Discussionmentioning

confidence: 99%

“…Most authors used fluorescence guidance with intraoperatively administered ICG for SLN localization of preoperatively depicted SLNs by CT lymphography [ 26 , 27 , 28 , 30 ]. As previously mentioned, matching of preoperative depicted SLNs and intraoperative fluorescent lymph nodes is challenging [ 90 ]. Secondly, the rapid lymphatic transportation, limited retention in SLNs and rapid washout of iopamidol increases the risk to overlook SLNs and of contrast-enhanced HEN(s) to erroneously being considered SLN(s).…”

Section: Discussionmentioning

confidence: 99%

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New Developments in Imaging for Sentinel Lymph Node Biopsy in Early-Stage Oral Cavity Squamous Cell Carcinoma

Mahieu

Maar

Nieuwenhuis

et al. 2020

Cancers

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Sentinel lymph node biopsy (SLNB) is a diagnostic staging procedure that aims to identify the first draining lymph node(s) from the primary tumor, the sentinel lymph nodes (SLN), as their histopathological status reflects the histopathological status of the rest of the nodal basin. The routine SLNB procedure consists of peritumoral injections with a technetium-99m [99mTc]-labelled radiotracer followed by lymphoscintigraphy and SPECT-CT imaging. Based on these imaging results, the identified SLNs are marked for surgical extirpation and are subjected to histopathological assessment. The routine SLNB procedure has proven to reliably stage the clinically negative neck in early-stage oral squamous cell carcinoma (OSCC). However, an infamous limitation arises in situations where SLNs are located in close vicinity of the tracer injection site. In these cases, the hotspot of the injection site can hide adjacent SLNs and hamper the discrimination between tracer injection site and SLNs (shine-through phenomenon). Therefore, technical developments are needed to bring the diagnostic accuracy of SLNB for early-stage OSCC to a higher level. This review evaluates novel SLNB imaging techniques for early-stage OSCC: MR lymphography, CT lymphography, PET lymphoscintigraphy and contrast-enhanced lymphosonography. Furthermore, their reported diagnostic accuracy is described and their relative merits, disadvantages and potential applications are outlined.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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New Developments in Imaging for Sentinel Lymph Node Biopsy in Early-Stage Oral Cavity Squamous Cell Carcinoma

Mahieu

Maar

Nieuwenhuis

et al. 2020

Cancers

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“…Other approaches with higher resolution lymphography using nonradioactive tracers currently under investigation include MRI and CT lymphography. These techniques use peritumoral injections of gadolinium‐ and iodine‐based contrast agents, respectively, and may be used to guide unilateral or bilateral ENI in patients with HNSCC and even neck treatment of selected lymph node levels 149,150 …”

Section: Future Perspectivesmentioning

confidence: 99%

Unilateral versus bilateral nodal irradiation: Current evidence in the treatment of squamous cell carcinoma of the head and neck

et al. 2021

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Cancers of the head and neck region often present with nodal involvement. There is a long‐standing convention within the community of head and neck radiation oncology to irradiate both sides of the neck electively in almost all cases to include both macroscopic and microscopic disease extension (so called elective nodal volume). International guidelines for the selection and delineation of the elective lymph nodes were published in the early 2000s and were updated recently. However, diagnostic imaging techniques have improved the accuracy and reliability of nodal staging and as a result, small metastases that used to remain undetected and were thus in the past included in the elective nodal volume, will now be included in high‐dose volumes. Furthermore, the elective nodal areas are situated close to the parotid glands, the submandibular glands and the swallowing muscles. Therefore, irradiation of a smaller, more selected volume of the elective nodes could reduce treatment‐related toxicity. Several researchers consider the current bilateral elective neck irradiation strategies an overtreatment and show growing interest in a unilateral nodal irradiation in selected patients. The aim of this article is to give an overview of the current evidence about the indications and benefits of unilateral nodal irradiation and the use of SPECT/CT‐guided nodal irradiation in squamous cell carcinomas of the head and neck.

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“…Several other techniques are currently under development in OSCC patients. These techniques include the use of PET-CT, CT lymphography, MRI lymphography using contrast agents or superparamagnetic iron oxide, contrast-enhanced ultrasound mapping using microbubbles, and freehand SPECT [52].…”

Section: Novel Tracersmentioning

confidence: 99%

What is the role of sentinel lymph node biopsy in the management of oral cancer in 2020?

Bree

Keizer

Civantos

et al. 2020

Eur Arch Otorhinolaryngol

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Approximately 70–80% of patients with cT1-2N0 oral squamous cell carcinoma (OSCC) ultimately prove to have no cancer in the cervical lymphatics on final pathology after selective neck dissection. As a result, sentinel lymph node biopsy (SLNB) has been adopted during the last decade as a diagnostic staging method to intelligently identify patients who would benefit from formal selective lymphadenectomy or neck irradiation. While not yet universally accepted, SLNB is now incorporated in many national guidelines. SLNB offers a less invasive alternative to elective neck dissection (END), and has some advantages and disadvantages. SLNB can assess the individual drainage pattern and, with step serial sectioning and immunohistochemistry (IHC), can enable the accurate detection of micrometastases and isolated tumor cells (ITCs). Staging of the neck is improved relative to END with routine histopathological examination. The improvements in staging are particularly notable for the contralateral neck and the pretreated neck. However, for floor of mouth (FOM) tumors, occult metastases are frequently missed by SLNB due to the proximity of activity from the primary site to the lymphatics (the shine through phenomenon). For FOM cancers, it is advised to perform either elective neck dissection or superselective neck dissection of the preglandular triangle of level I. New tracers and techniques under development may improve the diagnostic accuracy of SLNB for early-stage OSCC, particularly for FOM tumors. Treatment of the neck (either neck dissection or radiotherapy), although limited to levels I–IV, remains mandatory for any positive category of metastasis (macrometastasis, micrometastasis, or ITCs). Recently, the updated EANM practical guidelines for SLN localization in OSCC and the surgical consensus guidelines on SLNB in patients with OSCC were published. In this review, the current evidence and results of SLNB in early OSCC are presented.

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New Developments in Sentinel Lymph Node Biopsy Procedure in Localized Oral Cancer

Cited by 3 publications

References 8 publications

New Developments in Imaging for Sentinel Lymph Node Biopsy in Early-Stage Oral Cavity Squamous Cell Carcinoma

New Developments in Imaging for Sentinel Lymph Node Biopsy in Early-Stage Oral Cavity Squamous Cell Carcinoma

Unilateral versus bilateral nodal irradiation: Current evidence in the treatment of squamous cell carcinoma of the head and neck

What is the role of sentinel lymph node biopsy in the management of oral cancer in 2020?

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