Skip to main content

Advertisement

SpringerLink
Log in

Robot-assisted real-time sentinel lymph node mapping in oral cavity cancer: preliminary experience

  • Original Article
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

This study aims to assess the feasibility of using indocyanine green and robotic near infra-red fluorescent imaging (Firefly®) for sentinel lymph node biopsy in cN0 oral cavity cancer. Ten patients with early squamous cell carcinoma of the tongue (n = 8) and buccal mucosa (n = 2) were included. Peritumoral injection of 10 mg indocyanine green and real-time mapping of sentinel lymph nodes in the neck was performed using Firefly® via a retro-auricular trans-hairline incision. Sentinel lymph node was detected in all patients at 1.2 sentinel lymph node per person. Majority were situated in level II (91.7%). Mean time to detection of sentinel lymph node was 171.0 (68.0–312.0)s. Mean signal-to-background ratio was 5.62 (3.51–7.91). Frozen section of one sentinel lymph node was positive for malignancy, paraffin section of which confirmed the presence of metastatic disease. Modified radical neck dissection was performed for that particular patient, paraffin section of which did not show any tumor deposit. Frozen section and paraffin section of all other sentinel lymph nodes (n = 11) and neck dissection specimens yielded no malignancy. All resection margins were clear. Three patients completed adjuvant radiotherapy for pT2N0 (n = 2) and pT2N1 (n = 1) carcinoma of the tongue. Mean follow-up was 12.0 (4.0–18.0) months. All patients were alive at last follow-up with no disease recurrence. There were no adverse outcomes associated with the use of indocyanine green and robot-assisted neck dissection. Indocyanine green and Firefly® for sentinel lymph node biopsy in cN0 oral cavity cancer is feasible with no adverse effects.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Govers TM, Hannink G, Merkx MA, Takes RP, Rovers MM (2013) Sentinel node biopsy for squamous cell carcinoma of the oral cavity and oropharynx: a diagnostic meta- analysis. Oral Oncol 49:726e732

    Google Scholar 

  2. Loree JT, Popat SR, Burke MS, Frustino J, Grewal JS, Loree TR (2019) Sentinel lymph node biopsy for management of the N0 neck in oral cavity squamous cell carcinoma. J Surg Oncol 120(2):101–108

    PubMed  Google Scholar 

  3. Cramer JD, Sridharan S, Ferris RL, Duvvuri U, Samant S (2019) Sentinel lymph node biopsy versus elective neck dissection for stage I to II oral cavity cancer. Laryngoscope 129(1):162–169

    Article  Google Scholar 

  4. Christensen A, Juhl K, Charabi B, Mortensen J, Kiss K, Kjær A et al (2016) Feasibility of real-time near-infrared fluorescence tracer imaging in sentinel node biopsy for oral cavity cancer patients. Ann Surg Oncol 23(2):565–572

    Article  Google Scholar 

  5. Kim WS, Byeon HK, Park YM, Ha JG, Kim ES, Koh YW et al (2015) Therapeutic robot-assisted neck dissection via a retroauricular or modified facelift approach in head and neck cancer: a comparative study with conventional transcervical neck dissection. Head Neck 37(2):249–254

    Article  Google Scholar 

  6. Chow VL, Chan JY, Ng JC, Tsang RK (2020) Indocyanine green and Firefly® for real-time sentinel lymph node mapping in oral cavity cancer. Surg Oncol 32:88–89

    Article  Google Scholar 

  7. Bradley PJ, Ferlito A, Silver CE, Takes RP, Woolgar JA, Strojan P et al (2011) Neck treatment and shoulder morbidity: still a challenge. Head Neck 33(7):1060–1067

    Article  Google Scholar 

  8. van Wilgen CP, Dijkstra PU, van der Laan BF, Plukker JT, Roodenburg JL (2004) Morbidity of the neck after head and neck cancer therapy. Head Neck 26(9):785–791

    Article  Google Scholar 

  9. Lira RB, Chulam TC, de Carvalho GB, Schreuder WH, Koh YW, Choi EC et al (2018) Retroauricular endoscopic and robotic versus conventional neck dissection for oral cancer. J Robot Surg 12(1):117–129

    Article  Google Scholar 

  10. Al-Dam A, Precht C, Barbe A, Kohlmeier C, Hanken H, Wikner J et al (2018) Sensitivity and specificity of sentinel lymph node biopsy in patients with oral squamous cell carcinomas using indocyanine green fluorescence imaging. J Craniomaxillofac Surg 46(8):1379–1384

    Article  Google Scholar 

  11. Chan JY, Tsang RK, Wong ST, Wei WI (2015) Indocyanine green fluorescence mapping of sentinel lymph node in patients with recurrent nasopharyngeal carcinoma after previous radiotherapy. Head Neck 37(12):E169–E173

    Article  Google Scholar 

  12. van der Vorst JR, Schaafsma BE, Verbeek FP, Keereweer S, Jansen JC, van der Velden LA et al (2013) Near-infrared fluorescence sentinel lymph node mapping of the oral cavity in head and neck cancer patients. Oral Oncol 49:15e19

    Google Scholar 

  13. Bredell MG (2010) Sentinel lymph node mapping by indocyanin green fluorescence imaging in oropharyngeal cancer—preliminary experience. Head Neck Oncol 2:31

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Head and Neck Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China

    Velda Ling-Yu Chow, Judy Chun-Wai Ng, Jimmy Yu-Wai Chan, Wei Gao & Thian-Sze Wong

Authors
  1. Velda Ling-Yu Chow
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Judy Chun-Wai Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jimmy Yu-Wai Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wei Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thian-Sze Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Velda Ling-Yu Chow.

Ethics declarations

Conflict of interest

All authors (Dr. Velda Chow, Dr. Judy Ng, Dr. Jimmy Chan, Dr. Wei Gao and Dr. Thian-Sze Wong) declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chow, V.LY., Ng, J.CW., Chan, J.YW. et al. Robot-assisted real-time sentinel lymph node mapping in oral cavity cancer: preliminary experience. J Robotic Surg 15, 349–353 (2021). https://doi.org/10.1007/s11701-020-01112-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-020-01112-4

Keywords

Search

Navigation