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. 2009:2009:681746.
doi: 10.1155/2009/681746. Epub 2009 Nov 9.

Sentinel node detection in head and neck malignancies: innovations in radioguided surgery

L Vermeeren  1 , W M C Klop, M W M van den Brekel, A J M Balm, O E Nieweg, R A Valdés Olmos
Affiliations

Sentinel node detection in head and neck malignancies: innovations in radioguided surgery

L Vermeeren et al. J Oncol. 2009.

Abstract

Sentinel node mapping is becoming a routine procedure for staging of various malignancies, because it can determine lymph node status more precisely. Due to anatomical problems, localizing sentinel nodes in the head and neck region on the basis of conventional images can be difficult. New diagnostic tools can provide better visualization of sentinel nodes. In an attempt to keep up with possible scientific progress, this article reviews new and innovative tools for sentinel node localization in this specific area. The overview comprises a short introduction of the sentinel node procedure as well as indications in the head and neck region. Then the results of SPECT/CT for sentinel node detection are described. Finally, a portable gamma camera to enable intraoperative real-time imaging with improved sentinel node detection is described.

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Figures

Figure 1
Figure 1
SPECT/CT to rule out a presumed sentinel node. Anterior (a) and oblique (b) planar static images after 2 hours show drainage to the right neck on the basis of which 3 sentinel nodes were marked. SPECT/CT (c) demonstrates the cranial hotspot located at the base of the tongue in the oropharynx (arrow), due to leakage of the tracer from the injection area. The sentinel nodes are clearly visualized with SPECT/CT (d), while three-dimensional reconstruction (e) shows an anatomic overview of all hotspots.
Figure 2
Figure 2
SPECT/CT localizing sentinel nodes and providing anatomic overview. Anterior (a) and oblique (b) planar static images after 2 hours show several hotspots. Two-dimensional SPECT/CT reconstruction exactly localizes each node, for example, localizing 2 sentinel nodes in the submandibular region (c). Three-dimensional SPECT/CT reconstruction shows an anatomic overview of all sentinel nodes (d) and (e).
Figure 3
Figure 3
Development of portable gamma cameras. (a) First generation portable gamma camera with a weight of approximately 2 kg. (b) Portable gamma camera with a weight <1 kg but without support system. (c) Last generation portable gamma camera with improved ergometrical details and adequate support system for intraoperative use.
Figure 4
Figure 4
Localization and postexcision monitoring. Continuous monitoring (a) provides the possibility to record the whole procedure. With stepwise monitoring (b), the sentinel nodes are localized first, then excision takes place, and afterwards the portable gamma camera is used to screen for remaining activity. The laser pointer is positioned above the previous marked sentinel node level and the camera displays the technetium-signal (c), indicating that the node is located just right from the laser pointer. The portable gamma camera can also give an overview of the surgical field (d). It shows the injection area with a sentinel node located more caudally. After excision, the camera clearly shows no remaining radioactivity (d).
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