Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Jan;49(1):15-9.
doi: 10.1016/j.oraloncology.2012.07.017. Epub 2012 Aug 28.

Near-infrared fluorescence sentinel lymph node mapping of the oral cavity in head and neck cancer patients

Joost R van der Vorst  1 , Boudewijn E Schaafsma, Floris P R Verbeek, Stijn Keereweer, Jeroen C Jansen, Lilly-Ann van der Velden, Antonius P M Langeveld, Merlijn Hutteman, Clemens W G M Löwik, Cornelis J H van de Velde, John V Frangioni, Alexander L Vahrmeijer
Affiliations

Near-infrared fluorescence sentinel lymph node mapping of the oral cavity in head and neck cancer patients

Joost R van der Vorst et al. Oral Oncol. 2013 Jan.

Abstract

Objectives: Elective neck dissection is frequently performed during surgery in head and neck cancer patients. The sentinel lymph node (SLN) procedure can prevent the morbidity of a neck dissection and improve lymph node staging by fine pathology. Near-infrared (NIR) fluorescence imaging is a promising technique to identify the sentinel lymph node (SLN) intraoperatively. This feasibility study explored the use of indocyanine green adsorbed to human serum albumin (ICG:HSA) for SLN mapping in head and neck cancer patients.

Materials and methods: A total of 10 consecutive patients with oral cavity or oropharyngeal cancer and a clinical N0 neck were included. After exposure of the neck, 1.6 mL of ICG:HSA (500 μM) was injected at four quadrants around the tumor. During the neck dissection, levels I-IV were measured for fluorescence using the Mini-FLARE imaging system.

Results: In all 10 patients, NIR fluorescence imaging enabled visualization of one or more SLNs. A total of 17 SLNs were identified. The mean contrast between the fluorescent signal of the lymph nodes and of the surrounding tissue was 8.7±6.4. In 3 patients, of which 1 was false-negative, lymph node metastases were found. After administration of ICG:HSA, the average number of fluorescent lymph nodes significantly increased over time (P<0.001).

Conclusion: This study demonstrated feasibility to detect draining lymph nodes in head and neck cancer patients using NIR fluorescence imaging. However, the fluorescent tracer quickly migrated beyond the SLN to higher tier nodes.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Sentinel lymph node mapping using NIR fluorescence imaging in oropharyngeal cancer patients
Peritumoral injection of 1.6 mL of 500-μM ICG:HSA identifies a SLN (arrow) in an oropharyngeal cancer patient. M = sternocleidomastoid muscle and S = submandibular gland.
Figure 2
Figure 2. Sentinel lymph node mapping in head and neck cancer over time
One SLN (arrows) can be clearly identified 5 min (top row) postinjection of 1.6 mL of 500-μM ICG:HSA around the primary tumor. Identification of higher tier nodes was observed after 25 min (middle row), and the number of fluorescent lymph nodes increased further at 45 min postinjection (bottom row). M = sternocleidomastoid muscle and S = submandibular gland.
Figure 3
Figure 3. Lymph node identification as a function of postinjection time
Number of fluorescent lymph nodes (mean ± S.D.) is plotted as a function of time after injection of 500-μM ICG:HSA. The number of fluorescent lymph nodes significantly increased over time (P < 0.001)
See this image and copyright information in PMC

References

    1. Leemans CR, Tiwari R, Nauta JJ, van dW I, Snow GB. Regional lymph node involvement and its significance in the development of distant metastases in head and neck carcinoma. Cancer. 1993;71:452–456. - PubMed
    1. Layland MK, Sessions DG, Lenox J. The influence of lymph node metastasis in the treatment of squamous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx: N0 versus N+ Laryngoscope. 2005;115:629–639. - PubMed
    1. Sheahan P, O’Keane C, Sheahan JN, O’Dwyer TP. Effect of tumour thickness and other factors on the risk of regional disease and treatment of the N0 neck in early oral squamous carcinoma. Clin Otolaryngol Allied Sci. 2003;28:461–471. - PubMed
    1. 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;17:2459–2464. - PubMed
    1. Burcia V, Costes V, Faillie JL, Gardiner Q, de VD, Cartier C, et al. Neck restaging with sentinel node biopsy in T1-T2N0 oral and oropharyngeal cancer: Why and how? Otolaryngol Head Neck Surg. 2010;142:592–597. - PubMed

Publication types

MeSH terms