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Lymphatic mapping to tailor selective lymphadenectomy in cN0 tongue carcinoma: beyond the sentinel node concept

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

Abstract

Purpose

Cervical lymph node status is the most important pathological determinant of prognosis and decision making in head and neck squamous cell carcinoma (SCC). The aim of this study was to demonstrate that lymphoscintigraphy (LS) can supply a complete map of the lymphatic drainage before surgery, allowing planning of the type of intervention and serving to guide lymphadenectomy.

Methods

The study population comprised 14 patients with T2–4 SCCs of the tongue and clinically negative lymph nodes in the neck (cN0) who were scheduled to undergo tumour resection and selective level I–IV neck dissection extended to level V. LS was performed in all patients following the injection of 99mTc-colloidal sulphide in three aliquots around the primary lesion. Dynamic, static and tomographic images of the head and neck were acquired. The operative specimens were subjected to lymphoscintigraphic evaluation. Preoperative and postoperative imaging results were compared with the pathological findings. All nodes were examined using haematoxylin-eosin staining.

Results

Preoperative LS was successful in all patients. Preferential pathways of lymphatic drainage were identified: level II of the neck was the most common lymphatic drainage pattern, followed by levels IV and III. Contralateral drainage occurred in 11 patients and in two of them metastatic nodes were found on the contralateral side. Metastases were observed only in radioactive lymph nodes.

Conclusion

LS is able to supply a complete map of the lymphatic drainage before surgery, making it possible to tailor selective neck dissection to each individual patient based on the results of preoperative mapping, thereby sparing healthy lymphatic tissue and reducing surgery-related morbidity.

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Acknowledgements

This work was supported by grants from the Italian Association for Cancer Research (AIRC). The authors thank Deborah Console for editing the manuscript.

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Authors and Affiliations

  1. Nuclear Medicine, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy

    C. De Cicco, G. Trifirò, L. L. Travaini, M. Fiorenza & G. Paganelli

  2. Head and Neck Surgery Division, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy

    L. Calabrese, R. Bruschini & F. Chiesa

  3. Medical Physics Division, European Institute of Oncology, Milan, Italy

    M. E. Ferrari

  4. Pathology Division, European Institute of Oncology and University of Milan, Milan, Italy

    G. Viale

Authors
  1. C. De Cicco
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  2. G. Trifirò
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  3. L. Calabrese
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  4. R. Bruschini
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  5. M. E. Ferrari
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  6. L. L. Travaini
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  7. M. Fiorenza
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  8. G. Viale
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  9. F. Chiesa
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  10. G. Paganelli
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Corresponding author

Correspondence to C. De Cicco.

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De Cicco, C., Trifirò, G., Calabrese, L. et al. Lymphatic mapping to tailor selective lymphadenectomy in cN0 tongue carcinoma: beyond the sentinel node concept. Eur J Nucl Med Mol Imaging 33, 900–905 (2006). https://doi.org/10.1007/s00259-006-0088-4

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  • DOI: https://doi.org/10.1007/s00259-006-0088-4

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