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Tytuł:
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Development of sentinel lymph node biopsy technique in patients with salivary gland cancer using the IDEAL framework.
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Autorzy:
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Schilling C; Kings College London Dental Institute, Guys Hospital Great Maze Pond, SE1 9RT, UK. Electronic address: .
Gnanasegaran G; Department of Nuclear Medicine, Guys Hospital, Great Maze Pond London, SE1 9RT, UK.
Thavaraj S; Department of Oral and Maxillofacial Pathology, Guys Hospital, Great Maze Pond, London, SE1 9RT, UK.
Vojnovic B; Dental and Maxillofacial Imaging Department, Floor 23, Tower Wing, Guy's Hospital NHS Trust, Great Maze Pond, London, SE1 9RT, UK.
Ngu R; Department of Oncology, Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, UK.
McGurk M; Kings College London Dental Institute, Guys Hospital Great Maze Pond, SE1 9RT, UK.
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Źródło:
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European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2020 Nov; Vol. 46 (11), pp. 2029-2034. Date of Electronic Publication: 2020 May 31.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: : Amsterdam : Elsevier
Original Publication: London ; New York : Academic Press, [1985-
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MeSH Terms:
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Carcinoma, Acinar Cell/*pathology
Carcinoma, Adenoid Cystic/*pathology
Carcinoma, Mucoepidermoid/*pathology
Myoepithelioma/*pathology
Neck Dissection/*methods
Salivary Gland Neoplasms/*pathology
Sentinel Lymph Node Biopsy/*methods
Carcinoma, Acinar Cell/surgery ; Carcinoma, Adenoid Cystic/surgery ; Carcinoma, Mucoepidermoid/surgery ; Fluorescent Dyes ; Humans ; Indocyanine Green ; Myoepithelioma/surgery ; Optical Imaging ; Palatal Neoplasms/pathology ; Palatal Neoplasms/surgery ; Parotid Neoplasms/pathology ; Parotid Neoplasms/surgery ; Radiopharmaceuticals ; Salivary Gland Neoplasms/surgery ; Sublingual Gland Neoplasms/pathology ; Sublingual Gland Neoplasms/surgery ; Technetium Tc 99m Aggregated Albumin ; Tomography, Emission-Computed, Single-Photon
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Contributed Indexing:
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Keywords: Fluorescence guided surgery; Freehand; IDEAL framework; Neck dissection; SPECT; Salivary gland malignancy; Sentinel node biopsy
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Substance Nomenclature:
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0 (Fluorescent Dyes)
0 (Radiopharmaceuticals)
0 (Technetium Tc 99m Aggregated Albumin)
0 (technetium Tc 99m nanocolloid)
IX6J1063HV (Indocyanine Green)
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Entry Date(s):
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Date Created: 20200625 Date Completed: 20210301 Latest Revision: 20210301
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Update Code:
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20240105
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DOI:
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10.1016/j.ejso.2020.05.015
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PMID:
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32576478
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Background: Salivary cancer is rare and comprises a variety of histological subtypes and clinical behaviors. There is no agreed method of estimating the risk of occult metastasis or managing the clinically N0 neck.Sentinel node biopsy (SNB) may offer a solution but previous studies have not produced a reliable imaging protocol. This study uses novel technology and trial methodology to develop a reliable SNB technique, with primary aim to identify peri-and intraglandular sentinel nodes.
Methods: IDEAL framework was used to undertake SNB in clinically node negative salivary gland cancer. Patients with cT1-2 N0 salivary cancer were eligible. Lymphoscintigraphy was undertaken using Tc-99 m labelled nanocoll. Injection technique as well as adjunctive use of freehand SPECT (fhSPECT), near-infrared (NIR) fluorescence imaging, and navigation-guided surgery were used and optimisied during the study protocol.
Results: 10 patients were recruited. Initial protocol of peritumoural injection of Tc99 m nanocoll showed poor image resolution. Subsequent adjustment to single intratumoural injection allowed identification of intraglandular sentinel nodes. Fh/SPECT and NIR fluorescence imaging found intraglandular lymph nodes otherwise not recognizable to the naked eye. In two cases occult lymph node metastasis were identified.
Conclusion: This study has shown the IDEAL framework is vital in allowing iterative changes in surgical protocol in the light of experience. This study has produced a reliable method for detection of sentinel nodes, in particular the ability to identify intra- and periglandular nodes with diagnosis of occult metastatic deposits and no false negative results. Our protocol can be readily transferred in to larger scale studies.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
