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Sentinel lymph node mapping of clinically N0 early oral cancer: a diagnostic pitfall on CT lymphography

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Abstract

Objective

The purpose of this study was to reevaluate preoperative computed tomography lymphography (CTL) and enhanced CT images during follow-up to clarify whether SLNs enhanced by CTL were identified accurately before primary surgery with sentinel lymph node biopsy (SLNB) for clinically N0 early oral cancer.

Methods

Thirty two early oral cancer patients without cervical lymph node metastasis were enrolled in this study. To clarify whether SLNs enhanced by CTL were identified accurately before primary surgery with SLNB, we reevaluated preoperative CTL and enhanced CT images during follow-up in all patients.

Results

SLNs were detected by CTL in 31 of 32 patients (96.9%). During follow-up after primary surgery with SLNB, 4 of 27 patients without SLN metastasis had occult neck metastasis. Of the 4 patients, only 1 patient with cancer of floor of the mouth had overlooking of SLN, and the overlooking rate of SLN was 3.1%. The overlooked small SLN (2.9 × 3.3 × 3.1 mm) was located at contralateral level IB. The CT numbers before, 2, 5, 10 min after iopamidol injection, were 33 HU, 37 HU, 62 HU, 52 HU, respectively. The CT numbers of overlooked SLN 5 and 10 min after the injection was higher than CT images scanned before the iopamidol injection.

Conclusions

The enhancement of SLNs in CTL images after iopamidol injection should be compared sufficiently with CT images before iopamidol injection to avoid overlooking of SLNs in N0 early oral cancer.

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References

  1. Hanai N, Asakage T, Kiyota N, Homma A, Hayashi R. Controversies in relation to neck management in N0 early oral tongue cancer. Jpn J Clin Oncol. 2019;49:297–305.

    Article  Google Scholar 

  2. Shah JP. Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Am J Surg. 1990;160:405–9.

    Article  Google Scholar 

  3. Byers RM, Weber RS, Andrews T, McGill D, Kare R, Wolf P. Frequency and therapeutic implications of “skip metastases” in the neck from squamous cell carcinoma of the oral tongue. Head Neck. 1997;19:14–9.

    Article  Google Scholar 

  4. Honda K, Ishiyama K, Suzuki S, Oumi E, Sato T, Kawasaki Y, et al. Sentinel lymph node biopsy using computed tomographic lymphography in patients with early tongue cancer. Acta Otolaryngol. 2015;135:507–12.

    Article  Google Scholar 

  5. Morton DL, Bostick PJ. Will the true sentinel node please stand? Ann Surg Oncol. 1999;6:12–4.

    Article  Google Scholar 

  6. Rigual N, Loree T, Frustino J, Jayaprakash V, Cohan D, Sullivan M, et al. Sentinel node biopsy in lieu of neck dissection for staging oral cancer. JAMA Otolaryngol Head Neck Surg. 2013;139:779–82.

    Article  Google Scholar 

  7. Bilde A, von Buchwald C, Therkildsen MH, Mortensen J, Kirkegaard J, Charabi B, et al. Need for intensive histopathologic analysis to determine lymph node metastases when using sentinel node biopsy in oral cancer. Laryngoscope. 2008;118:408–14.

    Article  Google Scholar 

  8. Bredell MG. Sentinel lymph node mapping by indocyanine green fluorescence imaging in oropharyngeal cancer—preliminary experience. Head Neck Oncol. 2010;2:3.

    Article  Google Scholar 

  9. Iwai T, Maegawa J, Hirota M, Tohnai I. Sentinel lymph node biopsy using a new indocyanine green fluorescence imaging system with a color charged couple device camera for oral cancer. Br J Oral Maxillofac Surg. 2013;51:e26–e2828.

    Article  Google Scholar 

  10. Miura K, Hirakawa H, Uemura H, Yoshimoto S, Shiotani A, Sugasawa M, et al. Sentinel node biopsy for oral cancer: a prospective multicenter phase II trial. Auris Nasus Larynx. 2017;44:319–26.

    Article  Google Scholar 

  11. Den Toom IJ, Heuveling DA, Flach GB, Van Weert S, Karagozoglu KH, Van Schie A, et al. Sentinel node biopsy for early oral cavity cancer: the VU University Medical Center experience. Head Neck. 2015;37:573–8.

    Article  Google Scholar 

  12. Pedersen NJ, Hebbelstrup Jensen D, Hedbäck N, Frendø M, Kiss K, et al. Staging of early lymph node metastases with the sentinel lymph node technique and predictive factors in T1/T2 oral cavity cancer: a retrospective single-center study. Head Neck. 2016;38:E1033–E10401040.

    Article  Google Scholar 

  13. den Toom IJ, van Schie A, van Weert S, Karagozoglu KH, Bloemena E, Hoekstra OS, et al. The added value of SPECT-CT for the identification of sentinel lymph nodes in early stage oral cancer. Eur J Nucl Med Mol Imaging. 2017;44:998–1004.

    Article  Google Scholar 

  14. Abdul-Razak M, Chung H, Wong E, Palme C, Veness M, Farlow D, et al. Sentinel lymph node biopsy for early oral cancers: Westmead Hospital experience. ANZ J Surg. 2017;87:65–9.

    Article  Google Scholar 

  15. Khafif A, Schneebaum S, Fliss DM, Lerman H, Metser U, Ben-Yosef R, et al. Lymphoscintigraphy for sentinel node mapping using a hybrid single photon emission CT (SPECT)/CT system in oral cavity squamous cell carcinoma. Head Neck. 2006;28:874–9.

    Article  Google Scholar 

  16. Alkureishi LW, Ross GL, Shoaib T, Soutar DS, Robertson AG, Thompson R, et al. Sentinel node biopsy in head and neck squamous cell cancer: 5-year follow-up of a European multicenter trial. Ann Surg Oncol. 2010;17:2459–64.

    Article  Google Scholar 

  17. Mokhtar M, Tadokoro Y, Nakagawa M, Morimoto M, Takechi H, Kondo K, et al. Triple assessment of sentinel lymph node metastasis in early breast cancer using preoperative CTLG, intraoperative fluorescence navigation and OSNA. Breast Cancer. 2016;23:202–10.

    Article  Google Scholar 

  18. Yamamoto S, Suga K, Maeda K, Maeda N, Yoshimura K, Oka M. Breast sentinel lymph node navigation with three-dimensional computed tomography-lymphography: a 12-year study. Breast Cancer. 2016;23:456–62.

    Article  Google Scholar 

  19. Nakagawa M, Morimoto M, Takechi H, Tadokoro Y, Tangoku A. Preoperative diagnosis of sentinel lymph node (SLN) metastasis using 3D CT lymphography (CTLG). Breast Cancer. 2016;23:519–24.

    Article  Google Scholar 

  20. Yasuta M, Sato S, Ishida T, Kiyohara T. Usefulness of CT-lymphography in sentinel lymph node navigation. Int J Clin Oncol. 2014;19:557–62.

    Article  Google Scholar 

  21. Yuasa Y, Seike J, Yoshida T, Takechi H, Yamai H, Yamamoto Y, et al. Sentinel lymph node biopsy using intraoperative indocyanine green fluorescence imaging navigated with preoperative CT lymphography for superficial esophageal cancer. Ann Surg Oncol. 2012;19:486–93.

    Article  Google Scholar 

  22. Yoshida Y, Adachi K, Nakashima K, Yamane T, Yamamoto O. Difficulty to identify sentinel lymph nodes with computed tomography-lymphography in patients with cutaneous melanoma. Acta Derm Venereol. 2011;91:465–6.

    Article  Google Scholar 

  23. Tsujimoto H, Yaguchi Y, Sakamoto N, Kumano I, Takahata R, Matsumoto Y, et al. Computed tomography lymphography for the detection of sentinel nodes in patients with gastric carcinoma. Cancer Sci. 2010;101:2586–90.

    Article  Google Scholar 

  24. Saito M, Nishiyama H, Oda Y, Shingaki S, Hayashi T. The lingual lymph node identified as a sentinel node on CT lymphography in a patient with cN0 squamous cell carcinoma of the tongue. Dentomaxillofac Radiol. 2012;41:254–8.

    Article  Google Scholar 

  25. Sugiyama S, Iwai T, Izumi T, Ishiguro K, Baba J, Oguri S, et al. CT lymphography for sentinel lymph node mapping of clinically N0 early oral cancer. Cancer Imaging. 2019;19:72.

    Article  Google Scholar 

  26. Honda K, Ishiyama K, Suzuki S, Kawasaki Y, Saito H, Horii A. Sentinel lymph node biopsy using preoperative computed tomographic lymphography and intraoperative indocyanine green fluorescence imaging in patients with localized tongue cancer. JAMA Otolaryngol Head Neck Surg. 2019;145:735–40.

    Article  Google Scholar 

  27. Mølstrøm J, Grønne M, Green A, Bakholdt V, Sørensen JA. Topographical distribution of sentinel nodes and metastases from T1–T2 oral squamous cell carcinomas. Eur J Cancer. 2019;107:86–92.

    Article  Google Scholar 

  28. Bredell MG. Sentinel lymph node mapping by indocyanine green fluorescence imaging in oropharyngeal cancer—preliminary experience. Head Neck Oncol. 2010;2:31.

    Article  Google Scholar 

  29. Peng H, Wang SJ, Niu X, Yang X, Chi C, Zhang G. Sentinel node biopsy using indocyanine green in oral/oropharyngeal cancer. World J Surg Oncol. 2015;13:278.

    Article  Google Scholar 

  30. Al-Dam A, Precht C, Barbe A, Kohlmeier C, Hanken H, Wikner J, et al. Sensitivity and specificity of sentinel lymph node biopsy in patients with oral squamous cell carcinomas using indocyanine green fluorescence imaging. J Craniomaxillofac Surg. 2018;46:1379–84.

    Article  Google Scholar 

  31. van der Vorst JR, Schaafsma BE, Verbeek FP, Keereweer S, Jansen JC, van der Velden LA, et al. Near-infrared fluorescence sentinel lymph node mapping of the oral cavity in head and neck cancer patients. Oral Oncol. 2013;49:15–9.

    Article  Google Scholar 

  32. Fang Q, Li P, Qi J, Luo R, Chen D, Zhang X. Value of lingual lymph node metastasis in patients with squamous cell carcinoma of the tongue. Laryngoscope. 2019;129:2527–30.

    Article  Google Scholar 

  33. Jia J, Jia MQ, Zou HX. Lingual lymph nodes in patients with squamous cell carcinoma of the tongue and the floor of the mouth. Head Neck. 2018;40:2383–8.

    Article  Google Scholar 

  34. Ananian SG, Gvetadze SR, Ilkaev KD, Mochalnikova VV, Zayratiants GO, Mkhitarov VA, et al. Anatomic-histologic study of the floor of the mouth: the lingual lymph nodes. Jpn J Clin Oncol. 2015;45:547–54.

    PubMed  Google Scholar 

  35. Ando M, Asai M, Ono T, Nakanishi Y, Asakage T, Yamasoba T. Metastases to the lingual nodes in tongue cancer: a pitfall in a conventional neck dissection. Auris Nasus Larynx. 2010;37:386–9.

    Article  Google Scholar 

  36. Ozeki S, Tashiro H, Okamoto M, Matsushima T. Metastasis to the lingual lymph node in carcinoma of the tongue. J Maxillofac Surg. 1985;13:277–81.

    Article  Google Scholar 

  37. Dutton JM, Graham SM, Hoffman HT. Metastatic cancer to the floor of mouth: the lingual lymph nodes. Head Neck. 2002;24:401–5.

    Article  Google Scholar 

  38. Umeda M, Minamikawa T, Shigeta T, Oguni A, Kataoka T, Takahashi H, et al. Metastasis to the lingual lymph node in patients with squamous cell carcinoma of the floor of the mouth: a report of two cases. Kobe J Med Sci. 2010;55:E67–72.

    PubMed  Google Scholar 

  39. Nishio N, Fujimoto Y, Hiramatsu M, Yamamoto Y, Sone M. Sonographic detection of a lingual node metastasis from early squamous cell cancer of the tongue. J Clin Ultrasound. 2018;46:69–72.

    Article  Google Scholar 

  40. Han W, Yang X, Huang X, Hu Q, Wang Z. Metastases to lingual lymph nodes from squamous cell carcinoma of the tongue. Br J Oral Maxillofac Surg. 2008;46:376–8.

    Article  Google Scholar 

Download references

Funding

The funding was received by Japan Society for the Promotion of Science (Grant no. 26463020).

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan

    Satomi Sugiyama, Toshinori Iwai, Junichi Baba, Senri Oguri & Kenji Mitsudo

  2. Department of Radiology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan

    Toshiharu Izumi

  3. Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan

    Makoto Hirota

Authors
  1. Satomi Sugiyama
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  2. Toshinori Iwai
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  3. Toshiharu Izumi
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  4. Junichi Baba
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Correspondence to Toshinori Iwai.

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Conflict of interest

Satomi Sugiyama, Toshinori Iwai, Toshiharu Izumi, Junichi Baba, Senri Oguri, Makoto Hirota, Kenji Mitsudo declare that they have no conflict of interest.

Human rights statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

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Informed consent was obtained from the patient for being included in this study.

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Sugiyama, S., Iwai, T., Izumi, T. et al. Sentinel lymph node mapping of clinically N0 early oral cancer: a diagnostic pitfall on CT lymphography. Oral Radiol 37, 251–255 (2021). https://doi.org/10.1007/s11282-020-00442-1

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  • DOI: https://doi.org/10.1007/s11282-020-00442-1

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