technetium-tc-99m-medronate and Mouth-Neoplasms

This study aimed at evaluating the relevance of sentinel node detection by lymphoscintigraphy in patients diagnosed with squamous-cell carcinoma of the oral cavity in the absence of neck adenopathy.. A prospective study was carried out in 31 patients diagnosed with T1 to T3 squamous-cell carcinoma of the oral cavity without any clinically detectable neck adenopathy. A lymphoscintigraphy was performed the day before surgery. All patients underwent sentinel lymph node biopsy guided by a gamma-ray detecting probe and modified neck dissection. Pathologic evaluation of the sentinel lymph node included, in addition to the standard protocol, immunohistochemical analysis and thin sections of E stained preparations.. In 3 patients, the lymphoscintigraphy failed to detect any sentinel lymph node. In the remaining group of 28 patients, 20 patients showed a negative sentinel node concordant with a histologically negative neck dissection. In 5 patients, a positive lymph node was found although the rest of the neck dissection was negative. In 3 patients, sentinel lymph node was found to be negative but other neck nodes were positive. The overall sensitivity of lymphoscintigraphy in our study was 62%.. Surprisingly, the results of our study do not support the clinical usefulness of sentinel lymph node detection as a reliable and accurate staging method in patients with oral squamous cell carcinoma. We observed that lymphoscintigraphy was not a reliable method for detecting micrometastases in patients diagnosed with a squamous-cell carcinoma of the oral cavity without clinical evidence of neck matastases.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Humans; Lymph Nodes; Male; Middle Aged; Mouth Neoplasms; Neck; Neck Dissection; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Sentinel Lymph Node Biopsy; Technetium Tc 99m Medronate

The evaluation of the importance of the prognostic of sentinel node biopsy in head and neck cancer with N0 neck.. Prospective study included 19 patients with squamous cell carcinoma of the oral cavity, pharynx and larynx without enlarged lymph nodes in ultrasound examination (N0). The study was carried out in ENT Department of Medical University in Poznań between 2001-2004. Each patient underwent lymphoscintigraphy after administration of radionuclide Technetium 99m (Nanocol). In case of detection of sentinel node, blue dye was injected into the tumour bed and dyed lymph nodes were removed. The specimens were evaluated histologically and immunohistochemically. The patients are still followed up.. So far 19 patients were included in our study. The tumours were classified from T1 to T4. In each case sentinel nodes were located. Metastases in removed lymphnodes were found in 5 patients. In one of them regional recidive was observed after 5 month. In the other patients no changes were found in follow up examination. In 14 cases in histological examination no metastases were found in sentinel nodes. In this group in one case local recurrence was observed and in another two lymph nodes metastases were confirmed. In patients with positive sentinel node elective neck dissection was performed. So far immunohistochemical examination has not provided us with any vital information. In no case with negative sentinel node we found micrometastases with the use of cytokeratin.. Based on our preliminary observation of the patients we have found that there is certain correlation confirming the fact that sentinel node may be reliable for the whole neck lymphatic system. Further clinical observation are needed based on a larger number of patients and longer observation period.

Topics: Aged; Carcinoma, Squamous Cell; Female; Head and Neck Neoplasms; Humans; Laryngeal Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Mouth Neoplasms; Pharyngeal Neoplasms; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Medronate

This study was carried out to evaluate the diagnostic utility of gallium citrate Ga 67 ((67)Ga) and technetium Tc 99m bone scintigraphy as initial screening methods for distant metastasis and synchronous malignancies in patients with oral cancer.. Ga and/or bone scintigraphy was performed for 123 patients with primary squamous cell carcinoma (SCC). Abnormal accumulation sites detected with scintigraphy were reevaluated with radiography or computed tomography. Whether the accumulation sites were metastatic was determined according to the radiographic findings and the later clinical course of the patients.. Ga scintigraphy did not detect distant metastases or 4 synchronous cancers at other sites and provided no useful information on the emergence of delayed pulmonary metastases that developed in 3 cases after a few months. Ga scintigraphy showed an abnormal accumulation in 53% of primary tumors and 25% of metastatic cervical lymph nodes, and the detection of accumulation was closely related to the size of the lesion. Bone scintigraphy showed 1 case (0.9%) with distant metastasis to the vertebra; however, there were numerous false-positive cases that required additional radiographic confirmation.. These results suggested that Ga and bone scintigraphy at the initial examination of patients with primary oral SCC are ineffective for detecting distant metastasis and other malignancies because of the low incidence of these lesions and the diagnostic inaccuracy of scintigraphy.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Carcinoma, Squamous Cell; Citrates; Female; Follow-Up Studies; Gallium; Gallium Radioisotopes; Humans; Lymphatic Metastasis; Male; Middle Aged; Mouth Neoplasms; Neck; Neoplasm Staging; Neoplasms, Multiple Primary; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

We examined mandibular invasion of intraoral squamous cell carcinoma by simultaneous bone and tumor dual-isotope SPECT using (99m)Tc-hydroxymethylene diphosphonate ((99m)Tc-HMDP) and (201)Tl-chloride ((201)Tl) and by CT.. Early and delayed simultaneous bone and tumor dual-isotope SPECT and CT were performed on 39 patients suspected of having tumor invasion of the mandible by intraoral squamous cell carcinoma. SPECT images were superimposed to project tumor location from tumor SPECT onto the osseous structures shown by bone SPECT. The CT imaging protocol consisted of 5-mm contiguous axial images.. Histopathologic examination revealed invasion of the mandible in 13 patients and no tumor invasion in 26 patients. The results of delayed dual-isotope SPECT were exactly the same as those of early dual-isotope SPECT. On early and delayed dual-isotope SPECT, the sensitivity, specificity, and accuracy in detecting mandibular invasion by intraoral squamous cell carcinoma were 100% (13/13), 88.5% (23/26), and 92.3% (36/39), respectively. The corresponding values using CT were 45.5% (5/11), 94.7% (18/19), and 76.7% (23/30), respectively, when 9 patients were excluded because of dental artifacts.. Our results suggest that superimposed early bone and tumor dual-isotope SPECT images alone may be sufficient in the diagnostic evaluation of mandibular invasion by intraoral squamous cell carcinoma.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Humans; Male; Mandible; Middle Aged; Mouth Neoplasms; Neoplasm Invasiveness; Radiography; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Thallium; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Three-phase bone scintigraphy was undertaken to check the anastomotic patency and monitor the viability of vascularized bone grafts. Ten consecutive patients who underwent vascularized bone grafting of the mandible were reviewed. A successful clinical outcome was achieved in 8 patients. The graft failed in 2 patients. In this series, 3-phase bone scintigraphy of radiolabeled (99m)Tc-methylene-diphosphonate was performed at 7 days, and at 1, 3, 6, and 12 months after reconstruction. Assessments made using 3-phase bone images were compared with the clinical findings. The clinical outcome of the cases presented in our series correlated extremely well with 3-phase bone images. Three-phase bone scintigraphy is a useful method for the assessment of patency and viability of vascularized bone grafts. The use of this method can be very helpful in assessing the anastomotic patency and viability of a graft which for clinical reasons is suspected of being non-viable.

Topics: Aged; Anastomosis, Surgical; Bone Transplantation; Carcinoma, Squamous Cell; Female; Graft Survival; Humans; Male; Mandible; Mandibular Diseases; Middle Aged; Mouth Neoplasms; Osteoradionecrosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Vascular Patency

It is important for head and neck surgeons planning their operative approach to assess tumor infiltration to the mandible by intraoral squamous-cell carcinomas. Two- to 3-hr planar bone scintigraphy is sensitive but not specific in detecting mandibular invasion by tumor. We evaluated 3-hr SPECT bone scintigraphy, which provides better anatomical detail, to determine if it more accurately assesses tumor invasion.. Thirty consecutive patients with proven intraoral squamous-cell carcinomas were studied. Semiquantitative assessment of the mandible was performed with a three-level graded scoring system, based on comparisons of tracer uptake in the mandible to that in the upper cervical vertebrae and in an unaffected part of mandible. Lesion-to-cervical spine (L/S) count ratios and lesion-to-nonlesion (L/N) count ratios in the mandible on the 3-hr SPECT images were calculated.. All patients with proven tumor invasion showed higher tracer uptake than those with normal mandible or other dental diseases. The L/S and L/N count ratios on the SPECT images were significantly higher in patients with tumor invasion than in those without (L/S, p < 0.001; L/N, p < 0.01). L/S ratios provided better differentiation than L/N ratios.. Bone SPECT provides a reliable means of assessing tumor invasion to the mandible by intraoral squamous-cell carcinomas.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Cervical Vertebrae; Female; Humans; Male; Mandible; Mandibular Neoplasms; Middle Aged; Mouth Floor; Mouth Neoplasms; Neoplasm Invasiveness; Technetium Tc 99m Medronate; Time Factors; Tomography, Emission-Computed, Single-Photon

Detecting osseous involvement is clinically important in the management of oral carcinoma. Thirty-one patients with osseous involvement due to oral carcinoma who underwent panoramic radiography and bone scintigraphy were evaluated retrospectively. Bone scintigraphy confirmed osseous involvement in all 31 (100%) of these patients. In 27 (87%) of 31 patients with osseous involvement, both the panoramic radiogram and bone scintigram were positive. In the remaining four patients (13%), bone scintigram was positive for mandibular or maxillary invasion, while panoramic radiogram was negative. There were no instances of an abnormal radiogram with a normal bone scintigram. These findings strongly suggest that bone scintigraphy is more sensitive than panoramic radiography in detecting osseous involvement of the mandible and maxilla due to oral carcinoma. Furthermore, bone scintigraphy was a critical pre-surgical in determining the extent of the osseous involvement.

Topics: Carcinoma, Squamous Cell; Cheek; Diagnostic Errors; Evaluation Studies as Topic; Gingival Neoplasms; Humans; Mandibular Neoplasms; Maxillary Neoplasms; Melanoma; Mouth Neoplasms; Neoplasm Invasiveness; Radiography, Panoramic; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate

A prospective study of 85 patients with oral cancer, treated with high-dose radiation therapy, was performed to assess the value of magnetic resonance imaging (MRI) and scintigraphy for diagnosis of pathologic changes in the mandible. During postradiotherapeutic monitoring, radiation osteomyelitis occurred in 12 cases, tumor recurrences infiltrating the mandible in five cases, and progressive periodontal disease in nine cases. MRI permitted early diagnosis of radiation osteomyelitis in 11 out of 12 cases; only two cases were false positive. In scintigraphy with 99mTc-HDP, all alterations of the mandible, such as osteoradionecrosis, tumor infiltration, and periodontitis, showed a high uptake, resulting in a sensitivity of up to 100%, but a low specificity of 57%. Scintigraphy permitted assessment of the extension and location of the lesions. Both methods were superior to conventional radiography and clinical examination and should be integrated into a comprehensive follow-up program after radiation therapy.

Topics: Adult; Aged; False Positive Reactions; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Mandible; Mandibular Diseases; Mandibular Neoplasms; Middle Aged; Mouth Neoplasms; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Osteomyelitis; Osteoradionecrosis; Periodontitis; Prospective Studies; Radiation Injuries; Radiation Monitoring; Radiopharmaceuticals; Radiotherapy; Radiotherapy Dosage; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

To date no investigation has proven accurate and reliable for assessing mandibular invasion by carcinoma prior to surgery. This prospective study compared a new imaging modality, single photon emission computed tomography (SPECT), with clinical examination and high resolution CT scanning to evaluate the sensitivity and specificity of each method in detecting mandibular invasion by squamous cell carcinoma. Twenty-nine patients (21 men, 8 women) with an oral cavity/oropharyngeal carcinoma were studied. All underwent primary surgery and/or radiotherapy where indicated. Resected mandibles were decalcified and examined for tumour infiltration. Imaging studies were read independently by two experienced observers. Clinical examination predicted bone invasion with a sensitivity of 90% and a specificity of only 25%. CT had a sensitivity of 89% and a specificity of 57% while SPECT imaging had a sensitivity of 100% and a specificity of 29%. Using Fisher's exact test and the Kappa statistic for pairwise comparisons between each method, SPECT imaging was complementary to CT in the pre-operative assessment of mandibular invasion.

Topics: Aged; Carcinoma, Squamous Cell; Female; Humans; Male; Mandible; Mandibular Neoplasms; Mouth Neoplasms; Neoplasm Invasiveness; Oropharyngeal Neoplasms; Prospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The decision of whether to perform continuity-sparing or resecting surgery of the jaw in cases of malignant oral tumors is often difficult.. To aid in this decision, bone scintigraphy was evaluated retrospectively in 304 patients with a squamous cell carcinoma.. One hundred forty-five patients showed no accumulation of the radionuclide, and none of them had infiltration by tumor histologically.. It was concluded that a bone-sparing resection of tumors close to the jaw may be justified when there is a negative bone scan.

Topics: Adenocarcinoma; Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Adenoid Cystic; Carcinoma, Squamous Cell; Cheek; Child; Diphosphonates; False Negative Reactions; Female; Humans; Jaw Neoplasms; Lip Neoplasms; Male; Middle Aged; Mouth Floor; Mouth Neoplasms; Organotechnetium Compounds; Patient Care Planning; Predictive Value of Tests; Radiography; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Tongue Neoplasms

Several imaging techniques, such as conventional radiography, sonography, computed tomography, isotope scanning and magnetic resonance tomography are used for evaluation of malignant tumors in the region of the floor of the mouth and the tongue. At present, conventional radiography, as well as computed tomography and isotope scanning are the techniques preferred for examination of the mandible. In this study, the results of conventional radiographic examination, computed tomography, ultrasound and Tc scanning in detecting tumor invasion of the mandibular bone, are documented and correlated to surgical and histological findings. The results suggest that ultrasound--our primary diagnostic imaging technique for evaluation of tumors of the floor of the mouth and the tongue--not only provides excellent imaging of tumor extension in soft tissue but also allows accurate diagnosis of osteodestructions of the mandible. In most regions ultrasound had the same accuracy in detecting tumor invasion of the mandible. In the alveolar process, however, sonography was superior to other imaging techniques. The lingual surface of the mandibular ramus can not be screened by the extraoral sonography.

Topics: Carcinoma, Squamous Cell; Diagnostic Imaging; Female; Humans; Male; Mandibular Diseases; Mandibular Neoplasms; Middle Aged; Mouth Neoplasms; Neoplasm Invasiveness; Osteolysis; Radiography, Panoramic; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Ultrasonography