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Sentinel Node in Oral Cancer: The Nuclear Medicine Aspects. A Survey from the Sentinel European Node Trial

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Girolamo Tartaglione, Sandro J. Stoeckli, Remco De Bree, Clare Schilling, Geke B. Flach, Vivi Bakholdt, Jens Ahm Sorensen, Anders Bilde, Christian Von Buchwald, Georges Lawson, Didier Dequanter, Pedro M. Villarreal, Manuel Florentino Fresno Forcelledo, Julio Alvarez Amezaga, Augusto Moreira, Tito Poli, Cesare Grandi, Maurizio Giovanni Vigili, Michael O'Doherty, Davide Donner & 26 more Elisabeth Bloemena, Siavash Rahimi, Benjamin Gurney, Stephan K. Haerle, Martina A. Broglie, Gerhard F. Huber, Annelise I. Krogdah, Lars R. Sebbesen, Edward Odell, Luis Manuel Junquera Gutierrez, Luis Barbier, Joseba Santamaria-Zuazua, Manuel Jacome, Marie-Cecile Nollevaux, Emma Bragantini, Philippe Lothaire, Enrico M. Silini, Enrico Sesenna, Giles Dolivet, Romina Mastronicola, Agnes Leroux, Isabel Sassoon, Philip Sloan, Patrick M. Colletti, Domenico Rubello, Mark McGurk

Original languageEnglish
Pages (from-to)534-542
Number of pages9
JournalClinical Nuclear Medicine
Issue number7
Accepted/In press7 Mar 2016
PublishedJul 2016

King's Authors


Purpose: Nuclear imaging plays a crucial role in lymphatic mapping of oral cancer. This evaluation represents a subanalysis of the original multicenter SENT trial data set, involving 434 patientswith T1-T2, N0, and M0 oral squamous cell carcinoma. The impact of acquisition techniques, tracer injection timing relative to surgery, and causes of false-negative rate were assessed. 

Methods: Three to 24 hours before surgery, all patients received a dose of 99mTc-nanocolloid (10-175 MBq), followed by lymphoscintigraphy. According to institutional protocols, all patients underwent preoperative dynamic/ static scan and/or SPECT/CT. 

Results: Lymphoscintigraphy identified 723 lymphatic basins. 1398 sentinel lymph nodes (SNs) were biopsied (3.2 SN per patient; range, 1-10). Dynamic scan allowed the differentiation of sentinel nodes from second tier lymph nodes. SPECT/CT allowed more accurate anatomical localization and estimated SN depth more efficiently. After pathological examination, 9.9% of the SN excised (138 of 1398 SNs) showed metastases. The first neck level (NL) containing SN+ was NL I in 28.6%, NL IIa in 44.8%, NL IIb in 2.8%, NL III in 17.1%, and NL IV in 6.7% of positive patients. Approximately 96% of positive SNs were localized in the first and second lymphatic basin visualized using lymphoscintigraphy. After neck dissection, the SN+ was the only lymph node containing metastasis in approximately 80% of patients. 

Conclusions: Best results were observed using a dynamic scan in combination with SPECT/CT. A shorter interval between tracer injection, imaging, and surgery resulted in a lower false-negative rate. At least 2 NLs have to be harvested, as this may increase the detection of lymphatic metastases.

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