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. 2020 Apr;24(2):e125-e131.
doi: 10.1055/s-0039-1695762. Epub 2019 Nov 4.

Can Sentinel Lymph Node Biopsy Predict Various Levels of Echelon Nodes in Oral Cancers?

Ramya Rathod  1 , Jaimanti Bakshi  1 , Naresh Kumar Panda  1 , Roshan Verma  1 , Anish Bhattacharya  2 , Amanjit Bal  3
Affiliations

Can Sentinel Lymph Node Biopsy Predict Various Levels of Echelon Nodes in Oral Cancers?

Ramya Rathod et al. Int Arch Otorhinolaryngol. 2020 Apr.

Abstract

Introduction The efficacy of sentinel node biopsy in early stage oral cancer is well established. Its evolving role can be reinforced by further studies. Objective Analyzing the predictability of the levels of echelon nodes for various oral cavity tumor subsites on sentinel node biopsy. Methods A prospective study of 20 patients with stage I/II oral squamous cell carcinoma who underwent sentinel node biopsy-guided neck dissection between January 2017 and 2018 at our institute. The procedure included radiotracer injection, imaging (lymphoscintigraphy, single photon emission computed tomography-computed tomography), and gamma probe application. Sentinel node detection on imaging and gamma probe were compared. Results Out of 20 patients, 13 (65%) had carcinoma of the tongue, 6 (30%) had buccal mucosa carcinoma, and 1 (5%) had retromolar trigone carcinoma. The mean age of the patients was 52.3 years. A total of 13 (65%) patients were male, and 7 (35%) were female. The sentinel node identification rates with imaging and gamma probe were of 70% and 100% respectively. In tongue and retromolar trigone primaries, the most common first-echelon nodes in both modalities were levels IIA and IB respectively. For buccal mucosa primaries, first-echelon nodes were detected only with the gamma probe, which was level IB. On imaging, second-echelon nodes were detected only for tongue primaries, and had equivalent incidence of levels II, III, and IV. On the gamma probe, level IIA, followed by III, and IV for the tongue, and level IIA were the most common second-echelon nodes for the buccal mucosa. Third-echelon nodes were detected only with the gamma probe for tongue carcinoma at level IV. Conclusion The combined use of imaging and gamma probe provides the best results, with high identification rate and predictability of echelon levels.

Keywords: lymphoscintigraphy; neck dissection; oral cancer; sentinel node; technetium.

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Conflict of interest statement

Conflicts of Interest The authors have none to declare.

Figures

Fig. 1
Fig. 1
Radiotracer being injected in the anterior quadrant of the primary tumor, which is located on the middle third of the left lateral border of the tongue.
Fig. 2
Fig. 2
Imaging in a case of Carcinoma right lateral border of the tongue with detection of first- and second-echelon nodes. ( A ) Early dynamic imaging (arrows showing the locaation of sentinel lymph nodes). ( B ) Late static imaging. ( C ) Single photon emission computed tomography-computed tomography showing first-echelon node at level II and second-echelon node at level IV.
Fig. 3
Fig. 3
( A ) Gamma probe application after raising the subplatysmal flap. Postflap in vivo counts are recorded. ( B ). High radioactivity in the sentinel lymph node.
Fig. 4
Fig. 4
( A ) and ( B ) show the primary tumor subsite specific incidence of first- and second-echelon nodes at various levels on single photon emission computed tomography-computed tomography and gamma probe.
See this image and copyright information in PMC

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