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Intraoperative 3-D imaging improves sentinel lymph node biopsy in oral cancer

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to prospectively evaluate the feasibility and potential advantages of freehand single-photon emission computed tomography (fhSPECT) compared with conventional intraoperative localization techniques for sentinel lymph node biopsy (SLNB) in oral cancer.

Methods

Between November 2012 and February 2014, 23 consecutive patients with clinical T1/T2 oral squamous cell carcinoma and a cN0 neck were recruited. All patients underwent SLNB followed by elective neck dissection (END). All patients received preoperative lymphoscintigraphy. To detect the SLNs intraoperatively, fhSPECT with a combination of conventional acoustic SLN localization and 3-D visual navigation was used.

Results

All but one of the SLNs detected by preoperative imaging were successfully mapped intraoperatively by fhSPECT (detection rate 98 %), including those in six patients with a tumour in the floor of the mouth. A histopathology analysis revealed positive SLNs in 22 % of patients. No further metastases were found in LNs resected during END. SLNB correctly predicted the final LN stage in all patients (accuracy 100 %). Additional radioactive LNs, which were not present on preoperative lymphoscintigraphy, were observed in three patients.

Conclusion

FhSPECT is a feasible technology that allows the accurate identification of SLNs in oral cancer. FhSPECT overcomes the shine-through phenomenon, one of the most important limitations of SLNB, thereby confirming the importance of SLNB in patients with cN0 oral cancer.

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Disclosure

A.K.B. and K.H. are cofounders and shareholders of SurgicEye GmbH, Munich, Germany.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany

    Christina Bluemel, Ken Herrmann, Andreas K. Buck & Constantin Lapa

  2. Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Würzburg, Germany

    Alexander Kübler, Stefan Hartmann, Christian Linz & Urs Müller-Richter

  3. Institute of Pathology, University Würzburg, Würzburg, Germany

    Eva Geissinger & Vanessa Wild

Authors
  1. Christina Bluemel
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  2. Ken Herrmann
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  3. Alexander Kübler
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  4. Andreas K. Buck
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  5. Eva Geissinger
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  6. Vanessa Wild
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  7. Stefan Hartmann
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  8. Constantin Lapa
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  9. Christian Linz
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  10. Urs Müller-Richter
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Corresponding author

Correspondence to Ken Herrmann.

Additional information

Christina Bluemel, Ken Herrmann, Christian Linz and Urs Müller-Richter contributed equally to this work.

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Bluemel, C., Herrmann, K., Kübler, A. et al. Intraoperative 3-D imaging improves sentinel lymph node biopsy in oral cancer. Eur J Nucl Med Mol Imaging 41, 2257–2264 (2014). https://doi.org/10.1007/s00259-014-2870-z

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  • DOI: https://doi.org/10.1007/s00259-014-2870-z

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