Joint practice guidelines for radionuclide lymphoscintigraphy for sentinel node localization in oral/oropharyngeal squamous cell carcinoma

Abstract

Involvement of the cervical lymph nodes is the most important prognostic factor for patients with oral/oropharyngeal squamous cell carcinoma (OSCC), and the decision of whether to electively treat patients with clinically negative necks remains a controversial topic. Sentinel node biopsy (SNB) provides a minimally invasive method for determining the disease status of the cervical node basin, without the need for a formal neck dissection. This technique potentially improves the accuracy of histologic nodal staging and avoids overtreating three-quarters of this patient population, minimizing associated morbidity. The technique has been validated for patients with OSCC, and larger-scale studies are in progress to determine its exact role in the management of this patient population. This document is designed to outline the current best practice guidelines for the provision of SNB in patients with early-stage OSCC, and to provide a framework for the currently evolving recommendations for its use. Preparation of this guideline was carried out by a multidisciplinary surgical/nuclear medicine/pathology expert panel under the joint auspices of the European Association of Nuclear Medicine (EANM) Oncology Committee and the Sentinel European Node Trial (SENT) Committee.

Fig. 1

Patent Blue V dye

Fig. 2

Components of the gamma probe

Fig. 3

Pathology evaluation of sentinel lymph nodes

Fig. 4

Isolated tumor cells stained by AE1/AE3 in a sentinel lymph node

Fig. 5

A micrometastasis found in the seventh level of a sentinel node that was clear on initial sectioning. Viable nucleated squamous cells are present in a cohesive group. Section quality is suboptimal and recutting is not possible

Fig. 6

Cytokeratin-positive cells in a sentinel node stained by CKC pan cytokeratin. The white arrow shows a contaminant squame (this can be ascertained by the geometric outline, lack of nucleus, and by focusing at high power). The black arrows show nonnucleated individual tumor cells, and dendritic cells can be seen in the background

Fig. 7

A group of nucleated isolated tumor cells stained by AE1/AE3 in a sentinel node

Fig. 8

Multinucleated and mononuclear macrophages revealed by the detailed protocol in a sentinel node that was clear in the first sections. These were suspicious for ITCs within the island

Fig. 9

Adjacent field to Fig. 5 stained by AE1/AE3, showing absence of tumor cells