Document Detail

Lymphatic mapping to tailor selective lymphadenectomy in cN0 tongue carcinoma: beyond the sentinel node concept.
MedLine Citation:
PMID:  16604345     Owner:  NLM     Status:  MEDLINE    
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 (99m)Tc-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.
C De Cicco; G Trifirò; L Calabrese; R Bruschini; M E Ferrari; L L Travaini; M Fiorenza; G Viale; F Chiesa; G Paganelli
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-04-08
Journal Detail:
Title:  European journal of nuclear medicine and molecular imaging     Volume:  33     ISSN:  1619-7070     ISO Abbreviation:  Eur. J. Nucl. Med. Mol. Imaging     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-07-25     Completed Date:  2006-11-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101140988     Medline TA:  Eur J Nucl Med Mol Imaging     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  900-5     Citation Subset:  IM    
Nuclear Medicine, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
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MeSH Terms
Carcinoma, Squamous Cell / pathology,  radionuclide imaging*,  secondary*,  surgery
Lymph Node Excision / methods*
Lymph Nodes / pathology,  radionuclide imaging*,  surgery*
Lymphatic Metastasis
Middle Aged
Reproducibility of Results
Sensitivity and Specificity
Sentinel Lymph Node Biopsy
Surgery, Computer-Assisted / methods
Tongue Neoplasms / pathology,  radionuclide imaging*,  surgery*

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