technetium-tc-99m-sulfur-colloid and Carcinoma--Squamous-Cell

The goals of the research study were to develop an easily mastered, accurate, minimally invasive technique of sentinel node radiolocalization with biopsy (SNRLB) in the feline model; to compare it with blue-dye mapping techniques; and to test the applicability of sentinel node radiolocalization biopsy in three head and neck tumor types: N0 malignant melanoma, N0 Merkel cell carcinoma, and N0 squamous cell carcinoma.. Prospective consecutive series studies were performed in the feline model and in three head and neck tumor types: N0 malignant melanoma (43 patients), N0 Merkel cell carcinoma (8 patients), and N0 squamous cell carcinoma (20 patients).. The technique of sentinel node radiolocalization with biopsy was analyzed in eight felines and compared with blue-dye mapping. Patterns of sentinel node gamma emissions were recorded. Localization success rates were determined for blue dye and sentinel node with radiolocalization biopsy. In the human studies, all patients had sentinel node radiolocalization biopsy performed in a similar manner. On the morning of surgery, each patient had sentinel node radiolocalization biopsy of the sentinel lymph node performed using an intradermal or peritumoral injection of technetium Tc 99m sulfur colloid. Sentinel nodes were localized on the skin surface using a handheld gamma detector. Gamma count measurements were obtained for the following: 1) the "hot" spot/node in vivo before incision, 2) the hot spot/node in vivo during dissection, 3) the hot spot/node ex vivo, 4) the lymphatic bed after hot spot/node removal, and 5) the background in the operating room. The first draining lymph node(s) was identified, and biopsy of the node was performed. The radioactive sentinel lymph node(s) was submitted separately for routine histopathological evaluation. Preoperative lymphoscintigrams were performed in patients with melanoma and patients with Merkel cell carcinoma. In patients with head and neck squamous cell carcinoma, the relationship between the sentinel node and the remaining lymphatic basin was studied and all patients received complete neck dissections. The accuracy of sentinel node radiolocalization with biopsy, the micrometastatic rate, the false-negative rate, and long-term recurrence rates were reported for each of the head and neck tumor types. In the melanoma study, the success of sentinel node localization was compared for sentinel node radiolocalization biopsy, blue-dye mapping, and lymphoscintigraphy. In the Merkel cell carcinoma study, localization rates were evaluated for sentinel node radiolocalization biopsy and lymphoscintigraphy. In the head and neck squamous cell carcinoma study, the localization rate of sentinel node radiolocalization biopsy and the predictive value of the sentinel node relative to the remaining lymphatic bed were determined. All results were analyzed statistically.. Across the different head and neck tumor types studied, sentinel node radiolocalization biopsy had a success rate approaching 95%. Sentinel node radiolocalization biopsy was more successful than blue-dye mapping or lymphoscintigraphy at identifying the sentinel node, although all three techniques were complementary. There was no instance of a sentinel node-negative patient developing regional lymphatic recurrence. In the head and neck squamous cell carcinoma study, there was no instance in which the sentinel node was negative and the remaining lymphadenectomy specimen was positive.. In head and neck tumors that spread via the lymphatics, it appears that sentinel node radiolocalization biopsy can be performed with a high success rate. This technique has a low false-negative rate and can be performed through a small incision. In head and neck squamous cell carcinoma, the histological appearance of the sentinel node does appear to reflect the regional nodal status of the patient.

Topics: Adult; Aged; Aged, 80 and over; Animals; Carcinoma, Merkel Cell; Carcinoma, Squamous Cell; Cats; Coloring Agents; Female; Head and Neck Neoplasms; Humans; Lymphatic Metastasis; Lymphatic System; Lymphoscintigraphy; Male; Melanoma; Middle Aged; Radiopharmaceuticals; Rosaniline Dyes; Scintillation Counting; Sentinel Lymph Node Biopsy; Skin Neoplasms; Technetium Tc 99m Sulfur Colloid; Time Factors

To determine the accuracy of sentinel lymph node (SLN) detection in vulval carcinoma and to report the reliability and safety of this procedure.. For a period of 6 years, we recruited women undergoing surgery for vulval carcinoma. All women had a preoperative biopsy confirming the depth of invasion greater than 1 mm. Sentinel lymph node detection was performed using the combined method (Tc-99m and methylene-blue dye). The standard management included complete inguinofemoral lymphadenectomy. When inguinofemoral lymph nodes were found grossly to be enlarged, these nodes were debulked, and the women subsequently treated with radiotherapy with or without chemotherapy. During the last 2 years of the study, a selected group of women had an SLN dissection alone. The SLNs were ultrastaged when they were negative on routine hematoxylin and eosin examination.. Among 60 women undergoing SLN detection, SLN was detected in 59 women (98.3%) with combined method. Blue dye did not detect an SLN in 3 women resulting in a 93.3% detection rate. The median SLN count was 2 nodes (range, 1-9). Of the 60 women, 41 had inguinofemoral lymphadenectomy, 4 had only enlarged inguinofemoral nodes debulked, and 15 had the SLN only removed. The non-SLN count was 9 nodes (range, 3-17). There were no false-negative SLNs. Twenty-one women (35%) had positive nodes on final histology. Ultrastaging increased detection of metastases in 6.9% of nodes relative to routine hematoxylin and eosin examination and upstaged 12% of women. The median follow-up was 24 months (range, 2-66 months).. Sentinel lymph node detection is safe and accurate in assessing lymph node status in women with vulval cancer undergoing staging. The combined method using Tc-99m and methylene blue dye injection for SLN detection has the best detection rate. Routine ultrastaging of negative SLN improves the detection of nodal metastases.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Humans; Lymph Node Excision; Lymphatic Metastasis; Methylene Blue; Middle Aged; Neoplasm Staging; Practice Patterns, Physicians'; Prospective Studies; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Survival Rate; Technetium Tc 99m Sulfur Colloid; Treatment Outcome; Vulvar Neoplasms

Sentinel node mapping with radioactive technetium in non-small cell lung cancer has been shown to be feasible in several single institution reports. The Cancer and Leukemia Group B designed a phase II trial to test a standardized method of this technique in a multi-institutional setting. If validated, the technique could provide a more accurate and sensitive way to identify lymph node metastases.. Patients with clinical stage I non-small cell lung cancer amenable to resection were candidates for this trial. Intraoperatively, tumors were injected with technetium sulfur colloid (0.25 mCi). The tumor and lymph nodes were measured in vivo with a hand held Geiger counter and resection of the tumor and nodes was carried out. Sentinel nodes, all other nodes and the tumor were analyzed with standard histologic assessment. Negative sentinel nodes were also evaluated with immunohistochemistry.. In this phase II trial, 8 surgeons participated (1-13 patients enrolled per surgeon), and 46 patients (out of a planned 150) were enrolled. Of these, 43 patients had cancer and an attempted complete resection, and 39 patients underwent sentinel node mapping. One or more sentinel nodes were identified in 24 of the 39 patients (61.5%). The sentinel node(s) were found to be accurate (no other nodes were positive for cancer if the sentinel node was negative) in 20/24 patients (83.3%). In the overall group the sentinel node mapping procedure was found to be accurate in 20/39 patients (51.2%).. Intraoperative sentinel node mapping in lung cancer with radioisotope yielded lower accrual and worse accuracy than expected. The multi-institutional attempt at validating this technique was unsuccessful.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Carcinoma, Large Cell; Carcinoma, Non-Small-Cell Lung; Carcinoma, Squamous Cell; Feasibility Studies; Female; Humans; Lung Neoplasms; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Monitoring, Intraoperative; Neoplasm Staging; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Risk Factors; Sentinel Lymph Node Biopsy; Survival Rate; Technetium Tc 99m Sulfur Colloid; Treatment Outcome

Sentinel lymph node (SLN) dissections have a high sensitivity and negative predictive value for the detection of metastatic disease. The objective of this study was to examine the inguinal recurrence rate along with complication rates for patients undergoing inguinal SLN dissection alone for vulvar carcinoma.. An IRB approved prospective study enrolled patients with biopsy proven squamous cell carcinoma of the vulva. Peritumoral injection of Tc-99 sulfur colloid and methylene blue dye was used to identify SLNs intraoperatively. Patients with SLNs negative for metastatic disease were followed clinically. Patients with metastasis detected in a SLN subsequently underwent a full groin node dissection followed by standard treatment protocols.. Thirty-six patients were enrolled onto study with 35 undergoing a SLN dissection. All SNL dissections were successful with a mean of 2 SLN obtained per groin. There were 24 patients with stage I disease, 8 stage II, 3 stage III and 1 stage IV. A total of 56 SLN dissections were performed with 4 patients found to have inguinal metastasis by SLN dissection. There were 31 patients with a total of 46 SLN dissections found to be negative for metastatic disease. The median follow-up has been 29 months (range 8 to 51) with 2 groin recurrences for a groin recurrence rate of 4.3% and a recurrence rate per patient of 6.4%. There have been no reports of groin breakdown, extremity cellulitis or lymphedema.. The recurrence rate for patients undergoing inguinal sentinel node dissection alone is low. These patients did not experience any complications as seen with complete groin node dissections. Sentinel lymph node dissection should be considered as an option for evaluation of inguinal nodes for metastatic disease.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Cellulitis; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Lymphedema; Methylene Blue; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Prospective Studies; Radionuclide Imaging; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid; Vulvar Neoplasms

To report the initial experience with sentinel node identification using the gamma probe in patients with intermediate-risk penile cancer (T2NXM0, or T1 with intermediate or high-grade disease) and impalpable groin nodes.. Technetium-99m-labeled sulfur colloid was injected at the site of primary penile carcinoma 1 hour before surgery. The sentinel lymph nodes were located using the gamma probe and excised through a 3-cm inguinal incision. A full groin dissection was performed only in cases in which frozen section of the node demonstrated metastasis.. Nine sentinel nodes were identified by the gamma probe and excised in 5 men. In 3 patients, the sentinel nodes were negative bilaterally. In 2 patients, the sentinel node, although grossly normal, showed a single focus of metastasis by frozen section analysis. In both of these patients, a full groin dissection was carried out and revealed no other nodal metastases. All 5 remained free of recurrence (median follow-up 18 months, range 16 to 23).. In patients with microscopic involvement of a single lymph node only (confirmed by full groin dissection), gamma probe identification was 100% accurate. None of the patients with negative sentinel nodes had a recurrence. Biopsy of the sentinel nodes using the gamma probe can predict the presence or absence of inguinal node metastasis in patients with intermediate-risk penile cancer, sparing many patients the long-term morbidity of a full groin dissection. These initial results suggest further study is warranted.

Topics: Adult; Aged; Carcinoma, Squamous Cell; Follow-Up Studies; Groin; Humans; Lymph Node Excision; Lymphatic Metastasis; Male; Middle Aged; Penile Neoplasms; Prognosis; Radionuclide Imaging; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

Lymph node involvement is a strong predictor of disease recurrence and patient survival in vulvar cancer. The aim of the study was to evaluate the feasibility of sentinel lymph node (SLN) screening, the incidence of skip metastases, and lymph node lymphangiogenesis.. Fifty-five patients participated in this prospective, single centre study. A double SLN screening method was employed using radiocolloid (technetium-99 sulfur colloid) and 1.0% Isosulfan Blue. Immunohistochemistry, using a mouse monoclonal antibody against D2-40, was used to evaluate lymphatic vessel density (LVD). All calculations were performed using STATISTICA software v. 10 (StatSoft, USA, 2011); p < 0.05 was considered significant.. Using both methods of SLN detection, 100% accuracy was achieved, and skip metastases were diagnosed in only one woman (1.82%). Peri-tumour median LVD was significantly increased compared with matched intra-tumour samples (p < 0.001), while median LVD was significantly lower in negative, compared with positive SLN, regardless of whether matched non-SLN were negative (p < 0.001) or positive (p = 0.005). Metastatic SLN exhibited significantly higher median LVD compared with matched negative non-SLN (p = 0.015), while no significant difference in median LVD was detected between positive SLN and matched positive non-SLN. However, negative SLN had a significantly higher median LVD compared with matched negative non-SLN (p = 0.012).. SLN detection is a safe and feasible procedure in vulvar cancer. In patients without nodular involvement, SLN, compared with non-SLN, exhibited significantly higher median LVD, which may be an indication of its preparation to host metastases, and thus requires further investigation.

Topics: Aged; Animals; Antibodies, Monoclonal, Murine-Derived; Carcinoma, Squamous Cell; Female; Groin; Humans; Immunohistochemistry; Lymphangiogenesis; Lymphatic Metastasis; Mice; Neoplasm Staging; Prospective Studies; Rosaniline Dyes; Sentinel Lymph Node; Technetium Tc 99m Sulfur Colloid; Vulvar Neoplasms

The role of sentinel lymph node (SLN) biopsy alone for staging of early-stage cervical cancer remains controversial. We aimed to determine the validity of this technique in women with early-stage cervical cancer.. We retrospectively reviewed women with early-stage cervical cancer who underwent SLN mapping followed by complete pelvic lymphadenectomy as part of initial surgical management from August 1997 through October 2015. All modes of surgical approach were included. Lymphatic mapping was performed using blue dye, technetium-99m sulfur colloid (Tc-99), and/or indocyanine green (ICG). We determined SLN detection rates, sensitivity and negative predictive value.. In these women with early-stage cervical cancer, SLN biopsy had very high sensitivity and negative predictive value. We believe it is time to change the standard of care for women with early-stage cervical cancer to SLN biopsy only.

Topics: Adenocarcinoma; Adult; Aged; Carcinoma, Adenosquamous; Carcinoma, Squamous Cell; Coloring Agents; Female; Humans; Hysterectomy; Indocyanine Green; Laparoscopy; Lymph Node Excision; Lymphatic Metastasis; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Pelvis; Predictive Value of Tests; Radiopharmaceuticals; Retrospective Studies; Robotic Surgical Procedures; Sensitivity and Specificity; Sentinel Lymph Node; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid; Uterine Cervical Neoplasms; Young Adult

To compare the detection rate (DR) and bilateral optimal mapping (OM) of sentinel lymph nodes (SLNs) in women with endometrial and cervical cancer using indocyanine green (ICG) versus the standard technetium-99m radiocolloid ((99m)Tc) radiotracer plus methylene or isosulfan blue, or blue dye alone.. From October 2010 to May 2015, 163 women with stage I endometrial or cervical cancer (118 endometrial and 45 cervical cancer) underwent SLN mapping with (99m)Tc with blue dye, blue dye alone, or ICG. DR and bilateral OM of ICG were compared respectively with the results obtained using the standard (99m)Tc radiotracer with blue dye, or blue dye alone.. SLN mapping with (99m)Tc radiotracer with blue dye was performed on 77 of 163 women, 38 with blue dye only and 48 with ICG. The overall DR of SLN mapping was 97, 89, and 100 % for (99m)Tc with blue dye, blue dye alone, and ICG, respectively. The bilateral OM rate for ICG was 85 %-significantly higher than the 58 % obtained with (99m)Tc with blue dye (p = 0.003) and the 54 % for blue dye (p = 0.001). Thirty-one women (19 %) had positive SLNs. Sensitivity and negative predictive value of SLN were 100 % for all techniques.. SLNs mapping using ICG demonstrated higher DR compared to other modalities. In addition, ICG was significantly superior to (99m)Tc with blue dye in terms of bilateral OM in women with early stage endometrial and cervical cancer. The higher number of bilateral OM may consequently reduce the overall number of complete lymphadenectomies, reducing the duration and additional costs of surgical treatment.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Coloring Agents; Endometrial Neoplasms; Female; Follow-Up Studies; Humans; Indocyanine Green; Middle Aged; Prognosis; Radiopharmaceuticals; Retrospective Studies; Rosaniline Dyes; Sentinel Lymph Node; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid; Uterine Cervical Neoplasms

(99)TC combined with blue-dye mapping is considered the best sentinel lymph node (SLN) mapping technique in cervical cancer. Indocyanine green (ICG) with near infrared fluorescence imaging has been introduced as a new methodology for SLN mapping. The aim of this study was to compare these two techniques in the laparoscopic treatment of cervical cancer.. Medical records of patients undergoing laparoscopic SLN mapping for cervical cancer with either (99)Tc and patent blue dye (Group 1) or ICG (Group 2) from April 2008 until August 2012 were reviewed. Sensitivity, specificity, and overall and bilateral detection rates were calculated and compared.. Fifty-eight patients were included in the study-36 patients in Group 1 and 22 patients in Group 2. Median tumor diameter was 25 and 29 mm, and mean SLN count was 2.1 and 3.7, for Groups 1 and 2, respectively. Mean non-SLN (NSLN) count was 39 for both groups. SLNs were ninefold more likely to be affected by metastatic disease compared with NSLNs (p < 0.005). Sensitivity and specificity were both 100 %. Overall detection rates were 83 and 95.5 % (p = nonsignificant), and bilateral detection rates were 61 and 95.5 % (p < 0.005), for Groups 1 and 2, respectively. In 75 % of cases, SLNs were located along the external or internal iliac nodal basins.. ICG SLN mapping in cervical cancer provides high overall and bilateral detection rates that compare favorably with the current standard of care.

Topics: Adenocarcinoma; Adult; Carcinoma, Squamous Cell; Coloring Agents; Female; Follow-Up Studies; Humans; Indocyanine Green; Laparoscopy; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Neoplasm Staging; Optical Imaging; Prognosis; Prospective Studies; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid; Uterine Cervical Neoplasms

The purpose of this study was to assess the predictability of sentinel lymph node biopsy (SNB) for oral squamous cell carcinoma (OSCC) when pathologic processing is performed without serial step sectioning.. We prospectively enrolled 36 patients with T1 or T2 cN0 OSCC into this institutional review board-approved prospective cohort study, and they underwent gamma probe-guided SNB in addition to selective neck dissection. The rate of patients with negative SNB results whose neck dissection was also negative for metastasis (negative predictive value) was the primary endpoint.. Of the 28 patients whose sentinel lymph nodes were found to be pathologically and clinically node negative by routine hematoxylin-eosin stain and immunohistochemistry, 27 were found to have no other pathologically positive nodes, corresponding to a negative predictive value of 96%.. The results of this study suggest that SNB performed without the use of thin serial step sectioning may accurately predict neck stage in OSCC.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Cohort Studies; Coloring Agents; Eosine Yellowish-(YS); Fluorescent Dyes; Hematoxylin; Humans; Immunohistochemistry; Keratins; Lymph Nodes; Lymphatic Metastasis; Microtomy; Middle Aged; Mouth Neoplasms; Neck Dissection; Neoplasm Staging; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid; Young Adult

To study the utility of hybrid single photon emission computed tomography / computed tomography (SPECT/CT) scan and dual-dye technique in identification of the sentinel lymph node (SLN) in patients with an advanced malignant eyelid tumor.. Nonrandomized prospective interventional study.. setting: A tertiary eye care center. study population: Patients with an advanced malignant eyelid tumor without clinically involved regional lymph nodes. intervention: SLN biopsy was performed using dual-dye technique (a combination of radiotracer and vital blue dye) following localization by SPECT/CT. main outcome measures: Localization of SLN in the regional node basin by hybrid SPECT/CT scan; SLN identification rate using dual-dye technique; SLN positivity rate; false-negative rate; and complications, if any, of SLN biopsy.. Sixteen patients of biopsy-proven eyelid malignancy (7 squamous cell carcinomas [43.75%], 5 sebaceous cell carcinomas [31.25%], and 4 malignant melanomas [25%]) were included in the study. Preoperative localization of SLN was performed using SPECT/CT in 12 patients. SLN biopsy using dual-dye technique was performed in 16 patients. SPECT/CT accurately localized SLN in 11 out of 12 patients. The preauricular region was the most common site of SLN. SLN identification rates for dual-dye, radiotracer, and blue dye techniques were 100% (16/16 patients), 100% (16/16 patients), and 87.5% (14/16 patients), respectively. SLN showed metastasis in 2 patients (12.5%). On follow-up, 1 patient developed cervical lymph node metastasis, thus giving a false-negative rate of 7.14%. There were no complications associated with SLN biopsy.. Accurate preoperative localization of SLN in relation to adjacent anatomic structures using SPECT/CT aids in intraoperative identification of SLN. SLN biopsy should be considered in patients with eyelid tumors at significant risk for metastasis who have clinically negative nodal basins. Dual-dye technique is safe and feasible in advanced eyelid tumors. Blue dye technique can be used for SLN biopsy in settings where nuclear medicine facilities are not available, albeit with a lower SLN identification rate. Detection of metastasis in SLNs in ∼12% of cases emphasizes the utility of SLN biopsy in accurate staging and treatment of eyelid malignancies.

Topics: Adenocarcinoma, Sebaceous; Adult; Aged; Carcinoma, Squamous Cell; Coloring Agents; Eyelid Neoplasms; False Positive Reactions; Female; Humans; Lymph Node Excision; Lymphatic Metastasis; Lymphoscintigraphy; Male; Melanoma; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Predictive Value of Tests; Prospective Studies; Radiopharmaceuticals; Sebaceous Gland Neoplasms; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Although FDG PET is increasingly used for the staging of many types of sarcoma, little has been written regarding the FDG PET imaging characteristics of solitary fibrous tumor. We report a patient undergoing FDG PET/CT surveillance for squamous cell carcinoma of the tongue who was incidentally found to have two soft tissue masses in the retroperitoneum and pancreatic tail. Due to their low degree of FDG avidity, they were followed conservatively for approximately one year as they gradually increased in size. Technetium-99m sulfur colloid SPECT helped confirm that the pancreatic tail mass was not a splenule, after which both lesions were surgically resected and found to be extrathoracic solitary fibrous tumors without malignant features. These findings suggest that, as with other low-grade sarcomas, benign extrathoracic solitary fibrous tumors exhibit relatively little glycolytic metabolism in vivo.

Topics: Carcinoma, Squamous Cell; Fluorodeoxyglucose F18; Humans; Incidental Findings; Male; Middle Aged; Multimodal Imaging; Neoplasms, Multiple Primary; Pancreatic Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Retroperitoneal Neoplasms; Solitary Fibrous Tumors; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Tongue Neoplasms

The purpose of this study was to investigate the clinical value of radiolabeled tracer method, methylene blue method and combination of these two methods in detection of sentinel lymph node (SLN), and to evaluate the accuracy of SLN in predicting the cervical lymph nodes status in laryngeal carcinoma patients with clinically negative neck lymph nodes (cN0 ).. Forty-one patients with cN0 laryngeal neoplasms underwent SLN detection using both of radiolabeled tracer and methylene blue. SLN imaging was performed with laryngoscope-guided injection of radioactive isotope 99Tc(m)-sulfur colloid (SC) into the laryngeal carcinoma before surgery, then all these patients underwent intraoperative lymphatic mapping with a handheld gamma-detecting probe. After mapping of SLN, methylene blue was subsequently injected at the same spots around the tumor in order to identify SLN during surgery. The results of SLN detection by isotope tracer, dye and combination of both methods were compared.. The SLN detection rates by radiolabeled tracer, methylene blue and combined method were 87.8%, 70.7% and 92.7%, respectively (P < 0.01). The number of detected SLN was significantly different between radiolabeled tracer method and combined method (P < 0.05), and also between blue dye method and combined method (P < 0.01). However, no statistically significant difference was found between methylene blue method and radiolabeled tracer method (P > 0.05). Nine patients were found to have lymph node metastasis by final pathological examination. The sensitivity, accuracy and negative predictive values of SLN detection by the combined method using radiolabeled tracer and methylene blue were 88.9%, 97.4% and 96.7%, respectively.. The combined method using radiolabeled tracer and methylene blue can improve the accuracy of sentinel lymph node detection. Furthermore, sentinel lymph node detection can accurately predict the cervical lymph node status in cN0 laryngeal carcinoma.

Topics: Adolescent; Adult; Aged; Carcinoma, Squamous Cell; Female; Humans; Laryngeal Neoplasms; Larynx; Lymph Nodes; Lymphatic Metastasis; Male; Methylene Blue; Middle Aged; Neoplasm Staging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Young Adult

The existence of patients with positive non-sentinel node indicates a risk of misdiagnosis of metastasis in oropharyngeal and oral cancer.. We attempted to confirm the usefulness of sentinel lymph node biopsy (SLNB) in oropharyngeal and oral cavity cancer to detect clinically occult metastases.. Twenty-two patients with a mean age of 57 (SD=13) years were studied prospectively. All presented T1-T3 squamous cell carcinoma (SCC) of the oropharynx or oral cavity, and were cN0 on palpation and CT. A preoperative (24 h) lymphoscintigraphy was performed with 99mTc-labelled sulfur colloid injected around the primary tumor. Subsequently, we proceeded with tumor exeresis and detection of SLN following the procedures described in a previous paper.. We detected a total of 32 SLNs in 21 of 22 patients. Ipsilateral neck node location was observed in 18 patients and bilateral in 3. We observed 10 patients with true positive SLNs (3 patients had micrometastases), indicating occult metastases. We harvested a total of 454 nodes in our selective neck dissections, 19 of which presented metastatic invasion. We identified four patients with positive non-sentinel nodes.

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

Current management of N0 stage lip Squamous Cell Carcinoma (SCC) are prophylactic neck dissection, radiotherapy, or "watch and see" policy. The aim is the evaluation of the role of sentinel lymph node biopsy (SLNB) in their management based upon actual and not hypothetical presence of cervical lymph node (CLN) micrometastases as a same day procedure. Fourteen patients between November 2003 and August 2005 were included, nine men and five women, median age:57 years, (range 34-65 years). SLNB using preoperative lymphoscintigraphy and intra-operative localisation with patent blue and radioactive Tc(99m) Human Serum Albumin was performed. The median follow-up period was 26 months. Successful patent blue localisation in 13/14 whilst successful radio-localisation in all patients. Micrometastases were detected in 1/14 whom underwent therapeutic neck dissection. No local recurrence or regional lymph node involvement were detected. SLNB is a technically feasible and accurate approach for detection of CLN micrometastases in N0 stage lip SCC using the triple diagnostic localisation technique as a same day procedure.

Topics: Adult; Aged; Ambulatory Surgical Procedures; Carcinoma, Squamous Cell; Coloring Agents; Female; Follow-Up Studies; Humans; Lip Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid; Treatment Outcome

The objective of this study is to evaluate lymph node mapping for clinically positive neck metastasis using a sentinel node navigation technique.. 99mTc-labeled rhenium sulfide was injected as a radiotracer in 10 patients with squamous cell carcinoma of the tongue. After surgery, lymph nodes were classified into two categories according to the radioactive accumulation: nodes with radioactivity and nodes without radioactivity. The ratio of the metastatic area (RMA) of pathologically metastatic lymph nodes was measured.. In 5 of 10 cases, all of the metastatic nodes had radioactive accumulation. In one case with three metastatic nodes, radioactivity was not detected in one metastatic node, although it was detected in the other two nodes. In the other four cases, there were no radioactivities in any of the metastatic nodes. RMA of lymph nodes in which radioactivity was not detected was higher than that of lymph nodes in which radioactivity was detected. None of the nodes in which radioactivity was detected was fully occupied by metastatic carcinoma cells. In each case, in comparing the clinically positive lymph nodes, RMA of the nodes in which no radioactivity was detected was higher than that of the nodes in which radioactivity was detected.. The principle behind the sentinel node technique is detection of the node that has the most lymph flow from the tumor through injection of the tracer into the circumference of the tumor. When no radioactive accumulation is found in clinically positive metastatic lymph nodes, the possibility of metastasis to other lymph nodes should be highly suspected.

Topics: Adult; Aged; Carcinoma, Squamous Cell; Female; Glossectomy; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neck Dissection; Neoplasm Staging; Radionuclide Imaging; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid; Tongue Neoplasms

To determine the patterns of lymphatic drainage from primary vaginal cancers utilizing lymphoscintigraphy and to determine if this clinical information would affect treatment planning.. For women with newly diagnosed vaginal cancer, pretreatment lymphatic mapping and sentinel lymph node identification were performed using lymphoscintigraphy. In patients who underwent surgery, sentinel lymph nodes were identified intraoperatively using radiocolloid and patent blue dye. The impact of pretreatment lymphoscintigraphy findings on radiation planning in women who received radiation as initial treatment was noted.. Fourteen women were enrolled during the study period. At least 1 sentinel lymph node was identified on pretreatment lymphoscintigraphy in 11 patients (79%). The median number of sentinel nodes found per patient was 2, and bilateral sentinel nodes were found in 6 (55%) of the 11 patients with sentinel nodes identified. Among these 11 patients, 5 (45%) had sentinel nodes identified in the groin only, 4 (36%) had sentinel nodes identified in the pelvis only, and 2 (18%) had sentinel nodes identified in both the groin and the pelvis. No relationship was observed between sentinel lymph node location and primary tumor histologic subtype or location. Three (33%) of the 9 women treated initially with radiation therapy had their radiation field altered as a result of the lymphoscintigraphy findings.. In women with vaginal cancer, lymphatic drainage from the primary lesion does not always follow the lymphatic channels that would have been predicted anatomically. The addition of lymphoscintigraphy to the pretreatment evaluation for women with vaginal cancer may significantly improve comprehensive treatment planning.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Melanoma; Middle Aged; Pelvis; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid; Vaginal Neoplasms

We assessed the sensitivity of preoperative lymphoscintigraphy and dynamic sentinel node biopsy for staging the inguinal region of patients with penile cancer and no palpable inguinal adenopathy.. The records of 31 patients with invasive penile cancer and nonpalpable (29) or nonsuspicious (2) inguinal lymph nodes were reviewed. Preoperatively lymphoscintigraphy plus dynamic sentinel node biopsy with (99m)technetium labeled sulfur colloid and isosulfan blue dye was performed in 21 patients and dynamic sentinel node biopsy alone with blue dye only was done in 10. All patients underwent superficial lymph node dissection regardless of preoperative lymphoscintigraphy or dynamic sentinel node biopsy findings to establish pathological nodal status.. Six of 32 groins that showed drainage on preoperative lymphoscintigraphy had inguinal node metastasis, as did 1 of 10 that was drainage negative. The sensitivity of preoperative lymphoscintigraphy drainage for cancer detection was 86%. Using dynamic sentinel node biopsy with blue dye plus radiotracer 5 sentinel lymph nodes were positive for cancer, although 2 false-negative results were obtained. Thus, the sensitivity of dynamic sentinel node biopsy per groin for cancer detection was 71%.. In our experience preoperative lymphoscintigraphy and dynamic sentinel node biopsy as currently performed remain insufficient for detecting occult inguinal disease. Superficial lymph node dissection remains the gold standard for detecting inguinal microscopic metastasis in select patients.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Coloring Agents; Humans; Inguinal Canal; Male; Middle Aged; Neoplasm Staging; Penile Neoplasms; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Rosaniline Dyes; Sensitivity and Specificity; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

At present, there is no clinical examination that can accurately assess the lymph node metastasis status of oral tongue carcinoma with clinically negative neck lymph node (cN0) before operation. Therefore, the treatment of cN0 neck is still controversial. Sentinel lymph node (SLN) biopsy may be the evidence for individual treatment of cN0 neck. This study was to explore the feasibility of SLN radiolocalization, and to investigate the clinical value of SLN detection in squamous cell carcinoma of the oral tongue.. Twenty-one oral tongue squamous cell carcinoma patients with cN0 necks were recruited, among which 1 had received primary dissection before. 99mTc-SC, as the tracer, was injected into the submucosa around primary tumor before operation. Lymphoscintigraphy was performed immediately in 5 cases. The gamma probe was used to identify SLNs for all cases before and during operation. All patients received supraomohyoid neck lymph node dissection. The pathologic results were considered as golden standard to evaluate the effectiveness of SLN radiolocalization. SLNs that had been reported as negative by routine pathologic examination were examined by immunohistochemistry.. The detection rate of SLNs was 100%. Among the 21 patients, the pathologic results of SLNs for 21 patients accorded with the pathologic results of neck lymph node dissection; the accuracy rate was 95%. In 1 patient, the pathologic result of SLNs was negative, but that of neck lymph node dissection was positive. Micrometastases were found in 3 of 41 detected lymph nodes by immunohistochemstry.. SLN radiolocalization in squamous cell carcinoma of the oral tongue is feasible. SLN biopsy can well predict the cervical lymph node metastasis status of oral tongue carcinoma, but further investigation is necessary to determine its clinical value.

Topics: Adult; Aged; Carcinoma, Squamous Cell; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Radionuclide Imaging; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid; Tongue Neoplasms

Sentinel lymph node (SLN) biopsy seems to be a method that solves the problem of neck management with oral squamous cell carcinoma. Using blue dye methods for detection of neck SLNs from the surface of the operative field seems difficult; therefore, we used radiolocalization alone to detect and extract sentinel nodes. Aside from the various histological and clinical parameters examined in this procedure, we also determined whether they had any clinical significance in relation to the detection of SLNs during the operation.. Enrolled subjects had preoperative clinical N0 stage squamous cell carcinoma of the oral cavity and had received an unfiltered (99m)Tc sulfur colloid peritumoral injection. Localization of the SLNs was performed by using lymphoscintigraphy and a handheld gamma probe.. In total, 28 oral squamous cell carcinoma patients were included in this prospective study. Sixty-four SLNs in 27 patients were identified by this method. The identification rate was 96.4%. No false-negative predictions of SLN were noted among any of the patients studied. The numbers of the SLNs found during the operation were larger in patients with positive findings than those with negative findings (P < .05 by the Mann-Whitney U-test).. SLN radiolocalization provided an acceptable identification rate. The cases of positive findings for metastasis seemed to statistically have more SLNs than did those with negative findings, but more evidence is needed to prove this point. Therefore, SLN biopsies for extracting all possible high-risk nodes may be conducive for oral squamous cell carcinoma surgery.

Topics: Adult; Aged; Carcinoma, Squamous Cell; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Mouth Neoplasms; Neoplasm Staging; Radionuclide Imaging; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

To ascertain the feasibility of sentinel lymph node (SLN) localization by preoperative lymphoscintigraphy and intraoperative gamma probe radiolocalization and to determine the predictive value of the SLN for occult metastasis of the neck in N0 squamous cell carcinoma of the oral cavity and oropharynx.. A prospective study of 20 consecutive patients with N0 squamous cell carcinoma of the head and neck who underwent lymphoscintigraphy and SLN biopsy.. On the day before surgery, each patient who completed the study underwent a submucosal peritumoral injection of unfiltered technetium 99m sulfur colloid followed by lymphoscintigraphy. Focal areas of radioactivity were marked on the overlying skin. The following day, the patients underwent resection of the primary tumor, elevation of subplatysmal flaps, identification and removal of the SLNs as identified by gamma probe, and complete neck dissections.. Lymphoscintigraphy and gamma probe radiolocalization accurately identified 1 or more SLNs in all 20 patients. In 4 (20%) of the 20 patients, the SLN correctly identified metastatic disease. In no instance was the SLN negative when the lymphadenectomy specimen was positive.. In this study, the SLN had a negative predictive value of 100%. Sentinel lymph node biopsy is feasible and appears to accurately predict the presence of occult metastatic disease. Although further study is warranted, SLN biopsy could potentially guide head and neck oncologists to the patient with N0 disease who would benefit most from selective neck dissection and prevent the morbidity of unnecessary neck dissection.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Feasibility Studies; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Mouth Neoplasms; Oropharyngeal Neoplasms; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

Sentinel lymph node (SN) biopsy based on dual labeling with blue dye and radiocolloid can reliably determine lymph node status in early-stage cervical cancer, but few data are available on its accuracy in more advanced disease. We examined the influence of tumor stage on the accuracy of SN biopsy in patients with cervical cancer.. Between July 2001 and June 2004, 33 patients (mean age 52 years) with early-stage or locally advanced cervical cancer underwent laparoscopic SN biopsy based on dual labeling with patent blue and radiocolloid. Patients with early-stage cervical cancer (stages IA and IB1, 23 patients) underwent complete laparoscopic pelvic lymphadenectomy after the SN procedure. Patients with locally advanced cervical cancer (stage IB2, IIA or IIB, 10 patients) underwent laparoscopic pelvic and para-aortic lymphadenectomy after SN biopsy and prior neoadjuvant concomitant chemoradiotherapy. The SN identification rates and false-negative rates of patients with early-stage and locally advanced disease were compared.. The mean numbers of SNs identified per patient with early-stage and locally advanced cervical cancer were 2.3 (range 0-4) and 1.9 (range 0-4), respectively. SNs were identified in 86.9% (20/23) of patients with early-stage disease and in 80% (8/10) of patients with locally advanced disease. When analyzed according to the side of dissection, the identification rate was lower, especially in the patients with locally advanced disease (55% compared with 67.4%). The false-negative rate per patient was zero in early-stage disease and 20% (1/5) in locally advanced disease (no significant difference). When the side of dissection was taken into account, the false-negative rate improved to 42.9% (3/7) in patients with locally advanced disease and remained at zero in early-stage disease (P=0.038). Isolated blue dye was taken up in 53.3% of SNs in patients with locally advanced disease, compared with only 6.4% in patients with early-stage disease.. This study suggests that the SN biopsy technique with dual labeling is less accurate in locally advanced cervical cancer than in early-stage cervical cancer.

Topics: Adenocarcinoma; Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; False Negative Reactions; Female; Humans; Laparoscopy; Lymph Node Excision; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Radionuclide Imaging; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid; Uterine Cervical Neoplasms

The aim of this study was to investigate the feasibility and the morbidity of sentinel lymph node detection in patients with vulvar carcinoma. In 15 patients with vulvar squamous cell carcinoma, the inguinal sentinel lymph nodes was detected using both peritumoral injection of technetium-99m sulfur colloid and isosuflan blue before the surgical time. The detection of the inguinal sentinel lymph node was never completed by an inguinal lymphadenectomy. In case of metastatic lymph node, patients were treated by complementary inguinal irradiation. A total of 19 inguinal node dissection were performed. The sentinel lymph node was identified in 18/19 (94.7%) groin dissections. A total of 38 sentinel lymph nodes were removed. 4 patients were found to have metastatic lymph node (26.7%) with a total of 6 metastatic lymph nodes. The postoperative morbidity was minimal, with only one patient presenting a permanent edema of the extremity (6.7%) after complementary inguinal irradiation. We confirm the results of previous studies that sentinel node dissection appears to be technically feasible in patients with vulvar carcinoma. This may reduce the morbidity of usual inguinal lymphadenectomy without under-evaluate the nodal status. This procedure could be implemented in future therapy concepts.

Topics: Carcinoma, Squamous Cell; Feasibility Studies; Female; Humans; Inguinal Canal; Lymph Node Excision; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid; Vulvar Neoplasms

To evaluate the feasibility and staging ability of the sentinel node (SN) technique for patients with squamous cell carcinoma of the oral cavity or oropharynx and clinically negative necks. This prospective study compares the histopathologic status of the SN with that of the remaining neck dissection tissues.. Thirty previously untreated patients with T1 to T4 squamous cell carcinoma of the oral cavity or oropharynx and clinically negative necks (N0) were included in the study. Injection of 99m Tic-radiolabeled sulfur colloid around the primary tumor and lymphoscintigraphy were performed the day before surgery. Intraoperatively, the SN(s) was localized with a gamma probe and removed during neck dissection. The tumor was resected at the same time.. For 1 patient, lymphoscintigraphy revealed no SN. SN were identified in 29 patients/37 necks. In 29 necks, there were no positive SN. In 5 patients, the SN was the only histopathologically positive node. In 1 patient, SN and other nodes in the remaining neck tissue were positive. There was 1 false negative case; the first case of the study, indicating the need for a learning curve for the technique.. This prospective study shows that the SN is useful for the staging of N0 necks. The SN technique has the potential to decrease the need for neck dissections, which are usually performed in clinically negative necks, thus reducing both associated morbidity for patients and cost.

Topics: Carcinoma, Squamous Cell; False Negative Reactions; Feasibility Studies; Female; Head and Neck Neoplasms; Humans; Lymph Node Excision; Lymph Nodes; Male; Middle Aged; Mouth Neoplasms; Neoplasm Staging; Oropharyngeal Neoplasms; Prospective Studies; Radiology, Interventional; Radionuclide Imaging; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

This study was undertaken to assess the feasibility of lymphoscintigraphy of the gastric cardia and to identify the incidence of paraesophageal lymphatic drainage, precluding total gastrectomy with esophagojejunostomy as a potentially curative therapy for gastric cardia cancer.. Ten patients scheduled for esophagectomy with high-grade dysplasia or with esophageal cancer at least 3 cm above the esophagogastric junction were enrolled in this study. Preoperatively, 111 MBq of(99m)Tc-labeled nanocolloid (n = 5) or sulfur colloid (n = 5) were injected into the submucosa of the tumor-free cardia. Subsequently, lymphoscintigraphy in combination with CT was obtained. Locoregional lymph node stations were measured for radioactivity by a gamma-probe intraoperatively and ex vivo in the resection specimen.. In each patient, at least 1 radioactive lymph node station was detected. In total, 42 radioactive lymph node stations were detected by gamma-probe. Of those 42 areas, 38 (90%) were visible at preoperative lymphoscintigraphy. In the group of 5 patients in whom nanocolloid was used, a median of 2 (range, 1-4) node stations per patient was identified, whereas when sulfur colloid was administered a median of 6 (range, 4-8) active lymph node stations per patient could be detected (P < 0.002). Paraesophageal drainage was identified in 1 patient.. Lymphoscintigraphy of the gastric cardia is feasible and can accurately determine the location of radioactive lymph nodes. Early paraesophageal lymphatic drainage is rare.

Topics: Adenocarcinoma; Carcinoma, Squamous Cell; Cardia; Coloring Agents; Esophageal Neoplasms; Esophagectomy; Feasibility Studies; Humans; Lymph Nodes; Lymphoscintigraphy; Male; Middle Aged; Radiopharmaceuticals; Stomach Neoplasms; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid

We evaluated the feasibility of the sentinel lymph node technique to refine staging and potentially individualize therapy for anal cancer. Seventeen patients with cancer of the anal canal underwent peritumoral injection of 99mTc-colloid, followed 17 hours later by lymphoscintigraphy. A selective lymph node biopsy (SLNB) was attempted in 12 of 13 cases with scintigraphically detected SLNs. Lymph node metastases were present in 5 of 12 cases (42%); in 2 of these 5 cases, micrometastases were detected only by immunohistochemical staining. Hence, SLNB refines the diagnostic workup for anal cancer and provides an accurate basis for individualized therapy.

Topics: Adult; Aged; Aged, 80 and over; Anus Neoplasms; Carcinoma, Squamous Cell; Coloring Agents; Feasibility Studies; Female; Humans; Male; Middle Aged; Neoplasm Staging; Radiopharmaceuticals; Rosaniline Dyes; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

Detection of metastasis involvement of lymph nodes is essential for management and prognostic evaluation in most cancer cases. The success of lymphatic mapping depends on identifying the sentinel lymph node(s) draining the primary tumour. In this preliminary study we prospectively evaluated the feasibility of sentinel node radio localisation in head and neck squamous cell carcinoma N0 stage to gain insight as to whether the sentinel lymph node (SLN) could be prognostic of regional metastasis disease or not. In 14 patients with squamous cell carcinoma of the head and neck region preoperative lymphoscintigraphy (LSG) mapping of the tumour was performed after subcutaneous injection of 22 to 30 MBq of Tc99m-labelled sulfur colloid. SLN was detected and localised by LSG in all patients with a gamma camera and a hand-held gamma probe. All the patients underwent surgery SLN and cervical nodes dissection. Six SLNs for five patients revealed occult metastasis disease. No skip metastasis were found in the 9 necks with negative SLN analysis. The results of this preliminary study are encouraging. They showed that SLN in squamous cell carcinoma of the head and neck N0 is accurately feasible and could predict the presence of occult metastasis. Nevertheless, more data are needed to validate these results.

Topics: Adult; Aged; Carcinoma, Squamous Cell; Feasibility Studies; Female; Head and Neck Neoplasms; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

A simple method to detect silent aspiration during sleep has not been established in postsurgical oral cancer patients.. Radioactive paste consisting of (99m)TcO(4) (-) and carboxylmethylcellulose was prepared and placed in a maxillary prosthesis with a cavity in the palatal space. The patient was requested to wear this appliance during sleep, and the following morning the patient was subjected to scintigraphic scanning. Both the anterior and posterior aspects of the thorax were scanned using a Shimazu Medical gamma camera with window settings adjusted to a low energy collimator at 500 kilocounts per image.. Silent aspiration that had not been detected by videofluoroscopic examination was clearly demonstrated by the scintigraphic method, showing aspiration of radioactive paste during sleep in the left thorax of the patient.. The method reported for establishing aspiration is simple and reliable to assess silent aspiration during sleep in patients with oral cancer.

Topics: Aged; Carcinoma, Squamous Cell; Follow-Up Studies; Humans; Male; Mouth Neoplasms; Neoplasm Recurrence, Local; Pneumonia, Aspiration; Postoperative Complications; Postoperative Period; Radionuclide Imaging; Risk Assessment; Sensitivity and Specificity; Sleep; Technetium Tc 99m Sulfur Colloid

The goal of this study was to identify one or more inguinal sentinel nodes in patients with primary squamous cell carcinoma of the vulva and to determine the ability of the sentinel node to predict metastasis to the inguinal lymphatic basin.. Techniques employing technetium-99m (Tc-99m) sulfur colloid and isosulfan blue dye were utilized to identify sentinel nodes in the inguinal lymphatic beds. Technetium-99m sulfur colloid was injected intradermally at the tumor margins 90-180 min preoperatively followed by a similar injection of isosulfan blue dye 5-10 min before the groin dissection. A handheld collimated gamma counter was employed to identify Tc-99m-labeled sentinel nodes. Lymphatic tracts that had taken up blue dye and their corresponding sentinel node were also identified and retrieved. A completion inguinal dissection was then performed. Each sentinel node was labeled as hot and blue, hot and nonblue, or cold and blue. The sentinel nodes were subjected to pathologic examination with step sections and nonsentinel nodes were evaluated in the standard fashion.. Twenty-one patients with a median age of 79 were entered onto protocol and a total of 31 inguinal node dissections were performed. A sentinel node was identified in 31/31 (100%) groin dissections with the use of Tc-99m. Isosulfan blue dye identified a sentinel node in 19/31 (61%) groin dissections. Surgical staging revealed 7 patients with stage I disease, 5 with stage II disease, 5 with stage III disease, and 4 with stage IV disease. Lymph nodes in 9 groin dissections were found to have metastatic disease, and in 4 of these dissections, the sentinel node was the only positive node. Lymph nodes in 22 groin dissections had no evidence of metastasis. No false-negative sentinel lymph nodes were obtained (sentinel node negative and a nonsentinel node positive).. Tc-99m sulfur colloid is superior to isosulfan blue dye in the detection of sentinel nodes in inguinal dissections of patients with vulvar cancer. A sentinel node dissection utilizing Tc-99m alone can identify a sentinel node in all inguinal dissections. Pathologic examination with step sections has shown the sentinel node to be an accurate predictor of metastatic disease to the inguinal nodal chain.

Topics: Carcinoma, Squamous Cell; Female; Humans; Inguinal Canal; Lymphatic Metastasis; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Rosaniline Dyes; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid; Vulvar Neoplasms

In order to individualize the therapy in patients with anal cancer, we evaluated the applicability of the sentinel lymph node (SLN) concept for the staging of inguinal lymph nodes in these patients.. SLN mapping using the radiocolloid technique was performed in 12 patients with histopathologically proven anal cancer. Mean age of the 4 male and 8 female patients was 62 years (range: 37-83 years). All patients underwent injection of (99m)Tc-colloid (Nanocis) in 4 portions around the tumor followed by scintigraphy after 17 h and selective lymph node biopsy in case of nuclide enrichment. The nuclide-enriched lymph node was intraoperatively identified by a hand-held gamma-camera. Histopathological assessment of the harvested SLNs included serial sections and immunohistochemical staining.. Enrichment of radiocolloid in lymph nodes was seen in 10 of the 12 patients (detection rate: 83%). SLN biopsy was performed in 9 patients, one patient refused the SLN biopsy (SLNB). 4 patients revealed tumor-infiltrated sentinel lymph nodes including one patient with bilateral biopsy, who showed metastases unilaterally. The remaining 5 patients had no evidence of metastases in the excised SLNs.. It is feasible to evaluate the nodal status of the groin in patients with anal cancer using the radiocolloid technique. Preliminary results indicate a refined diagnostic work-up for anal cancer patients, potentially improving the results of clinical and sonographical examinations. Further application of the method may lead to an individualized treatment of patients with anal cancer.

Topics: Adult; Aged; Aged, 80 and over; Anus Neoplasms; Carcinoma, Squamous Cell; Feasibility Studies; Female; Gamma Cameras; Humans; Lymph Node Excision; Lymph Nodes; Male; Middle Aged; Neoplasm Staging; Pilot Projects; Prognosis; Radionuclide Imaging; Rectal Neoplasms; Sentinel Lymph Node Biopsy; Survival Rate; Technetium Tc 99m Sulfur Colloid

Sentinel lymph node biopsy is a minimally invasive method to stage the regional lymphatics that has revolutionized the management of patients with intermediate-thickness cutaneous melanoma. Head and neck surgeons have been encouraged by the accuracy of sentinel lymph node biopsy in cutaneous melanoma and have applied the technique to patients with head and neck squamous cell carcinoma (HNSCC). The objectives of the study were 1) to study the feasibility and accuracy of sentinel lymph node biopsy as a method to stage the regional lymphatics in HNSCC and 2) to determine whether there are qualitative differences between the cutaneous and mucosal lymphatics that would affect the technique used in HNSCC.. Two methods of investigation were employed: a prospective laboratory study using a feline model for sentinel lymph node biopsy and a retrospective review of patients who received lymphoscintigraphy before neck dissection and intraoperative identification of the sentinel lymph node.. Lymphoscintigraphy and a gamma probe were used in four felines to study the kinetics of technetium-labeled sulfa colloid (Tc-SC) in the mucosal lymphatics. In the second part of the feline study, eight subjects were studied intraoperatively. Tc-SC and isosulfan blue dye were used to study the injection technique for the mucosal lymphatics and to determine the time course of the dye and Tc-SC to the sentinel lymph node. In Part II of the present study, a retrospective review of 33 patients with HNSCC was conducted. Twenty patients (stage N0) whose treatment included elective neck dissection were studied with preoperative lymphoscintigraphy and underwent intraoperative identification of the sentinel lymph node to determine the accuracy and feasibility of sentinel lymph node biopsy. Eight patients with palpable neck disease and five patients with recurrent or second primary disease whose previous treatment included neck dissection were also studied with lymphoscintigraphy before neck dissection.. In the feline study, both Tc-SC and isosulfan blue dye traversed the lymphatics rapidly, appearing in the sentinel lymph node in less than 5 minutes. Modification of the injection technique used for cutaneous melanoma was required to depict the sentinel lymph node of the base of tongue. In the human study, the sentinel lymph node was accurately identified in 19 of 20 (95%) N0 patients. On average, 2.9 sentinel lymph nodes (range, 1-5) were identified in 2.2 (range, 1-4) levels of the neck. Sentinel lymph nodes were bilateral in 4 of 19 patients. When the sentinel lymph node was identified, it accurately predicted the pathological nodal status of the regional lymphatics. Three of 20 patients had cervical metastases, and the sentinel lymph node was identified in 2 of 3 patients with pathologic nodes (pN+). Focal areas of radiotracer uptake were identified in seven of eight patients with palpable disease. These areas corresponded to the level with palpable disease in four patients. The lymphatics delineated by lymphoscintigraphy in the five patients with previous neck dissection were outside the levels that had been dissected. Lymphoscintigraphy depicted collateral patterns of lymphatic drainage.. Sentinel lymph node biopsy is technically feasible and is a promising, minimally invasive method for staging the regional lymphatics in patients with stage N0 HNSCC. Lymphoscintigraphy alone may determine the levels that require treatment in patients with disrupted or previously operated cervical lymphatics.

Topics: Adult; Aged; Animals; Carcinoma, Squamous Cell; Cats; Feasibility Studies; Head and Neck Neoplasms; Humans; Lymphatic System; Lymphoscintigraphy; Melanoma; Middle Aged; Neck Dissection; Neoplasm Staging; Radiopharmaceuticals; Rosaniline Dyes; Sentinel Lymph Node Biopsy; Skin Neoplasms; Technetium Tc 99m Sulfur Colloid

This study aimed to evaluate the ability of lymphoscintigraphy (LSG) to direct sentinel node biopsy (SNB) in the identification of occult metastases in the clinically N0 neck for patients with head and neck squamous cell carcinoma (HNSCC). 57 clinically N0 neck sides in 48 patients were assessed using the triple diagnostic approach of pre-operative LSG, intra-operative use of a gamma probe and blue dye. SNB was performed after radiocolloid and blue dye injection. Pre-operative LSG and the intra-operative use of a gamma probe identified radioactive sentinel nodes, and visualization of blue stained lymphatics identified blue sentinel nodes. 104 sentinel nodes were harvested from 43 patients. The identification rate was 90% (43 of 48). Of the 104 nodes harvested, 17 of 62 (27%) nodes identified as both radioactive and blue were positive for occult metastases compared with 5 of 42 (12%) nodes identified as hot or blue only (p<0.05). Sentinel nodes were identified in 39 of 48 (81%) patients using LSG. Of 39 patients in whom sentinel nodes were identified using LSG, 37 of 39 (95%) had radioactive sentinel nodes harvested intra-operatively. In patients who had no sentinel nodes identified on LSG, 4 of 9 (44%) had radioactive sentinel nodes harvested intra-operatively. This difference was statistically significant using the t-test (p<0.05). LSG directs SNB and is essential in the identification of occult metastases within the clinically N0 neck for patients with HNSCC.

Topics: Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Lymphatic Metastasis; Neoplasm Staging; Radionuclide Imaging; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

To evaluate the feasibility and predictive ability of the sentinel node localization technique for patients with squamous cell carcinoma of the oral cavity or oropharynx and clinically negative necks.. Prospective, efficacy study comparing the histopathologic status of the sentinel node with that of the remaining neck dissection specimen.. Tertiary referral center.. Patients with T1 or T2 disease and clinically negative necks were eligible for the study. Nine previously untreated patients with oral cavity or oropharyngeal squamous cell carcinoma were enrolled in the study.. Unfiltered technetium Tc 99m sulfur colloid injections of the primary tumor and lymphoscintigraphy were performed on the day before surgery. Intraoperatively, the sentinel node(s) was localized with a gamma probe and removed after tumor resection and before neck dissection.. The primary outcome was the negative predictive value of the histopathologic status of the sentinel node for predicting cervical metastases.. Sentinel nodes were identified in 9 previously untreated patients. In 5 patients, there were no positive nodes. In 4 patients, the sentinel nodes were the only histopathologically positive nodes. In previously untreated patients, the sentinel node technique had a negative predictive value of 100% for cervical metastasis.. Our preliminary investigation shows that sentinel node localization is technically feasible in head and neck surgery and is predictive of cervical metastasis. The sentinel node technique has the potential to decrease the number of neck dissections performed in clinically negative necks, thus reducing the associated morbidity for patients in this group.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Feasibility Studies; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Mouth Neoplasms; Neck; Oropharyngeal Neoplasms; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

Topics: Carcinoma, Squamous Cell; Humans; Lymph Nodes; Lymphatic Metastasis; Neck Dissection; Otorhinolaryngologic Neoplasms; Radionuclide Imaging; Reproducibility of Results; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

To determine the feasibility of sentinel node radiolocalization in stage N0 in head and neck squamous cell carcinoma and to gain insight as to whether the sentinel node could be prognostic of regional micrometastatic disease.. A prospective report on the application sentinel node radiolocalization in eight patients with N0 squamous cell carcinoma of the head and neck region.. For each patient a peritumoral submucosal injection of filtered technetium (99mTc) prepared with sulfur colloid was performed immediately following intubation. After at least 30 minutes, focal areas of accumulation corresponding to a sentinel node were marked on the skin surface. Complete neck dissections were performed, and the sentinel nodes were identified for later histological evaluation and comparison to the remaining lymphadenectomy specimen.. Sentinel node radiolocalization accurately identified two or more sentinel lymph nodes in all eight cases. In one patient, two of the three lymph nodes containing micrometastatic disease were sentinel lymph nodes. There was no instance in which sentinel node was negative for micrometastatic disease while being positive in a nonsentinel lymph node.. Accurate localization of the sentinel lymph node using radiolabeled sulfur-colloid is feasible in patients with squamous cell carcinoma of the head and neck region. Although sentinel node radiolocalization in head and neck squamous cell cancer may potentially reduce the time, cost, and morbidity of regional lymph node management, more experience with technique is required before its role can be determined.

Topics: Aged; Carcinoma, Squamous Cell; Feasibility Studies; Female; Head and Neck Neoplasms; Humans; Male; Prognosis; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

Management of the N0 neck in head and neck squamous cell carcinoma is an important issue for the head and neck surgeon. Experience with radionuclide-labeled colloid injection to identify a sentinel node in malignant melanoma suggests a high level of accuracy for this approach to identify microscopic metastasis when present. We set out to explore the feasibility of using the handheld gamma probe to identify radiolabeled sentinel nodes in oral squamous cell carcinoma.. Five individuals with N0 necks and accessible oral or oropharyngeal primary sites from a major tertiary referral center.. Radiolabel with unfiltered technetium Tc 99m sulfur colloid was injected in quadrants around the primary site followed by immediate dynamic lymphoscintigraphy. Open biopsy of the sentinel node was accomplished within 2 hours of injection after extirpation of the primary site. Regional or complete neck dissection was performed after sentinel node biopsy.. Sentinel node biopsy accurately identified one or several nodes in 2 cases, including nodes containing metastatic cancer in 1. In the other 3 cases, the radiolabel failed to identify the sentinel node despite the presence of metastatic disease in the nodes at final pathologic study in 2.. Detection and biopsy of the sentinel node are feasible for selected patients with oral head and neck squamous cell carcinoma with N0 necks. There is a potential savings of time, cost, and morbidity with this approach. However, several substantial problems were encountered with the technique in this limited series of patients. Establishing the reliability of lymphoscintigraphy in this setting would require testing in a much larger patient cohort. Our experience suggests that such an investment may not be warranted.

Topics: Adult; Aged; Biopsy; Carcinoma, Squamous Cell; Feasibility Studies; Female; Gamma Rays; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Mouth Neoplasms; Neck Dissection; Neoplasm Staging; Oropharyngeal Neoplasms; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Sulfur Colloid

Lymph node imaging has been helpful in managing patients with lymphoma, melanoma, and breast cancer. To evaluate 38 patients with head and neck cancers, 99mTc minicolloid was injected adjacent to the tumor and into a similar area on the uninvolved side. Lymphoscintigraphy of the neck was performed at 3- and 5-hour intervals after injection and bilateral cervical lymphatic drainage was observed. Each patient then underwent a neck dissection. The pathologic node findings were then correlated with the neck scans. Results confirmed that cervical lymphatic drainage is unpredictable in 50% of the patients once the channels are involved with metastatic disease. Lymphoscintigraphy is not a reliable method of detecting early metastatic cervical carcinoma.

Topics: Carcinoma, Squamous Cell; False Negative Reactions; False Positive Reactions; Head and Neck Neoplasms; Humans; Lymph Nodes; Lymphatic Metastasis; Neck; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

A patient with squamous cell carcinoma of the lung had splenic uptake of Tc-99m MDP on two consecutive bone scans, but not on a third. There was no intervening therapy. At autopsy the spleen was grossly and microscopically normal.

Topics: Bone and Bones; Carcinoma, Bronchogenic; Carcinoma, Squamous Cell; Diphosphonates; Humans; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Spleen; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

A retrospective analysis of 104 chest radionuclide angiography (CRNA) studies establishes the utility of this procedure in the evaluation of pulmonary malignancies and benign masses. Remarkable abnormalities in the perfusion of the lungs were identified in 36 (58%) of 62 cases that were not predictably normal or predictably abnormal form the clinical setting. While 60 of these 62 cases involved malignancy being evaluated for metastases, only 21 (34%) had metastases identified by radionuclide bone or liver-spleen scintigraphy. In addition to diagnosis of superior vena cava obstruction, the CRNA may have a more frequent application as an adjunct to routine scintigraphic studies directed to the identification of metastatic disease.

Topics: Adenocarcinoma; Aged; Carcinoma, Squamous Cell; Diphosphonates; Female; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Vena Cava, Superior

A tracheo-esophageal fistula, developed following radiotherapy for an esophageal carcinoma, was vividly demonstrated by radionuclide imaging. The abnormality was later confirmed by a barium esophagram and endoscopic examinations. The scintigraphic procedure, making use of a Tc-99m sulfur colloid swallow, appears to be a simple alternative method that may be clinically useful for the diagnosis of such a condition.

Topics: Barium Sulfate; Carcinoma, Squamous Cell; Esophageal Neoplasms; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tracheoesophageal Fistula

A method of studying lymphatic drainage of the larynx was undertaken using radioactive colloids. Sites of injection were the true and false cords, aryepiglottic folds, anterior and posterior commissure, epiglottis and arytenoid. The patient was then scanned with the gamma camera 3 to 5 hours and again 24 hours post injection. Thirty-six patients were injected and results were recorded as to previous X-ray therapy, nodal activity post scanning, ipsilateral or contralateral and distant spread, and the type of radioactive particle--99mTc labeled sulfur colloid, 99mTc microalbumin (200-800 nm diameter), and 99mTc minimicroalbumin (less than 50 nm diameter). The three radiopharmaceuticals gave similar results. Previous X-ray therapy did not alter lymphatic drainage. Of 36 patients, 23 showed nodal activity on scintiscanning: none showed any axillary nor mediastinal activity.

Topics: Carcinoma, Squamous Cell; Humans; Injections, Intralymphatic; Laryngeal Diseases; Laryngeal Neoplasms; Larynx; Lymph Nodes; Lymphoscintigraphy; Neck; Serum Albumin; Sulfur; Technetium; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid