technetium-tc-99m-sulfur-colloid and Hypopharyngeal-Neoplasms

We sought to analyze the characteristics of radioactive lymph nodes with metastatic disease and to explore methods for the localization of sentinel lymph nodes (SLNs) with radionuclide in clinically N0 laryngeal and hypopharyngeal cancer.. Forty-five patients with T1-T4 and clinically N0 laryngeal and hypopharyngeal cancer were recruited. For each patient, a peritumoral submucosal injection of 99mTc-labeled sulfur colloid was administered, and lymph node mapping was performed by lymphoscintigraphy 2 hours after injection. The SLNs were localized during operation by a hand-held gamma probe 10 to 12 hours after the injection, and we defined the radioactive counts from the parotideomasseteric region as background values. All lymph nodes that had accumulated radioactivity were harvested and initially termed as SLNs. Selective neck dissection was performed in all patients. The SLN specimens were sent for formal paraffin-embedded sectioning, serial sectioning, and immunohistochemical assay. The results were compared to those for the remaining lymphadenectomy specimen. Resection of the primary tumor depended on its location and the T classification.. Sentinel lymph nodes were identified in 41 of 45 patients (51 necks). Sentinel lymph nodes with occult metastases were found in 13 patients (15 necks). In a false-negative case, metastasis was found in a nonsentinel lymph node in 1 of the neck specimens. The SLN identification rate was 92.7%, the sensitivity was 93.7%, the false-negative rate was 6.3%, and the accuracy was 98.0%. In 11 of the 15 necks (73.3%) with pathologically positive SLNs, metastasis was found in the node with the highest radioactivity. Harvesting the first 3 nodes with the highest radioactive counts may identify patients with occult metastatic disease.. Excision of the first 3 SLNs with the highest radioactive counts can be used to accurately identify the status of cervical lymph node metastases in patients with clinically N0 laryngeal or hypopharyngeal cancer.

Topics: Adult; Aged; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Hypopharyngeal Neoplasms; Laryngeal Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neck; Neoplasm Staging; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Technetium Tc 99m Sulfur Colloid

To analyze the characteristic of the radioactive lymph node with metastatic disease and to explore the method of the localization of sentinel lymph node (SLN) with radionuclide in N0 clinically laryngeal and hypopharyngeal cancer.. Fourty-five patients with T1-T4 and clinically N0 laryngeal and hypopharyngeal cancer were recruited. For each patient a peritumoral submucosal injection of 99mTc-labeled sulfur colloid (99mTc-SC) was performed and lymph node mapping was performed by lymphoscintigraphy two hours afterward. The SLN was localized by a handheld gamma probe intraoperatively 10-12 hours after the injection. All hot lymph nodes accumulating activity were harvested and initially termed sentinel nodes. Selective neck dissections were performed for all patients. The specimen of SLN was sent to the pathologist for the following analysis: formal paraffin embedded section, consecutive section and immunohistochemistry assay. The results was compared to the remaining lymphadenectomy specimen. Resection of the primary tumour depended on the location and the T classification.. SLNs were identified in 41 of 45 patients with 51 necks, SLNs had occult metastases in 13 cases, 15 necks with SLN-positive of these 13 cases, there was one false negative case, they were found in non-SLNs of neck specimens. Each neck side was considered a single case. SLN identification rate was 92.7%, sensitivity was 93.7%, false-negative rate was 6.3%, and accuracy was 98.0%. In 11 (73.3%) of these SLN-positive necks, the SLN with the highest counts contained tumor; harvesting the first-three nodes with the highest radioactive counts, which could all patients with occult metastatic disease.. Excision of the first-three SLNs with the highest radioactive counts can accurately judge the presence or absence of the cervical lymph nodes metastases in patients with the clinically N0 laryngeal and hypopharyngeal cancer.

Topics: Adult; Aged; Female; Humans; Hypopharyngeal Neoplasms; Laryngeal Neoplasms; Lymph Nodes; Male; Middle Aged; Radioactive Tracers; Radionuclide Imaging; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid