Staging N0 Oral Cancer: Lymphoscintigraphy and Conventional Imaging

• Published in: Acta radiologica (1987) 2005-08, Vol.46 (5), p.492-496
• Main Authors: Thomsen, J. B., Sørensen, J. A., Grupe, P., Karstoft, J., Krogdahl, A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Cardiovascular system; Chi-Square Distribution; Chlorides; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; Mouth - diagnostic imaging; Mouth - pathology; Mouth Neoplasms - mortality; Mouth Neoplasms - pathology; Neoplasm Staging; Otorhinolaryngology. Stomatology; Palpation - methods; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Rhenium; Sensitivity and Specificity; Sentinel Lymph Node Biopsy - methods; Sulfides; Technetium; Tumors; Ultrasonic investigative techniques; Ultrasonography, Doppler - methods; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology
• ISSN: 0284-1851; 1600-0455
• DOI: 10.1080/02841850510021373

Purpose: To compare sentinel lymph node biopsy, magnetic resonance imaging (MRI), Doppler ultrasonography, and palpation as staging tools in patients with T1 T2 N0 cancer of the oral cavity. Material and Methods: Forty consecutive patients were enrolled (17 F and 23 M, aged 32-90 years), 24 T1 and 16 T2 cN0 squamous cell carcinoma of the oral cavity. Palpation was carried out by two observers prior to inclusion. MRI, gray-scale and Doppler ultrasonography were performed. Lymphoscintigraphies were done after peritumoral injections of 99mTc labelled rheniumsulphide nanocolloid, followed by sentinel lymph node biopsy guided by a gamma probe and Patent Blue. Palpation, Doppler ultrasonography, MRI, and sentinel lymph node biopsy were compared to a combination of histopathology and follow-up. Diagnostic testing was performed using the x2 test. Results: Histopathological examination revealed metastatic spread to the neck in 14 of 40 patients. One patient had bilateral neck disease. Sentinel lymph node biopsy and ultrasonography were performed in 80 neck sides of 40 patients and MRI in 70 neck sides (5 patients were claustrophobic). SN revealed suspicious lymph nodes in 12 necks, ultrasonography in 23 necks, and MRI in 9 necks. The positive predictive value of sentinel lymph node biopsy was 100%, ultrasonography 57%, and MRI 56%. The respective negative predictive values were 96%, 96%, and 85%. The sensitivity of sentinel lymph node biopsy 80% was comparable to ultrasonography 87%, but the sensitivity of MRI 36% was low. The specificities were 100%, 85%, and 93%, respectively. By combined sentinel lymph node biopsy and ultrasonography the overall sensitivity could have been 100%. Conclusion: Sentinel lymph node biopsy improved staging of patients with small N0 oral cancers. Combined sentinel lymph node biopsy and Doppler ultrasonography may further improve staging. MRI and simple palpation results were poor.