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Current Pharmaceutical Design


ISSN (Print): 1381-6128
ISSN (Online): 1873-4286

Research Article

A Novel Sentinel Lymph Node Approach in Oral Squamous Cell Carcinoma

Author(s): Åsa Kågedal, Gregori Margolin, Cornelia Held, Pedro F. N. da Silva, Krzysztof Piersiala, Eva Munck-Wikland, Hans Jacobsson, Valtteri Häyry* and Lars O. Cardell

Volume 26, Issue 31, 2020

Page: [3834 - 3839] Pages: 6

DOI: 10.2174/1381612826666200213100750

Price: $65


Background: Occult metastases are common in patients with oral squamous cell carcinoma (OSCC) which is why elective neck dissection, adjuvant radiotherapy or watchful waiting have been treatment options after surgical removal of the primary tumour. Sentinel lymph node biopsy (SLNB) has lately emerged as a novel possibility in treatment planning.

Objectives: To establish a reliable and clinically useful protocol for SLNB in staging/elective neck dissection in oral cancer.

Methods: Fourteen consecutive patients with T1-T2 N0 oral cancer were enrolled when scheduled for elective neck dissection.

Results: This study outlines various techniques for improving SLNB in head and neck cancer. After evaluation, a combination of techniques was found to constitute a reliable, clinically adaptable work concept. The suggested procedure starts with the pre-surgical injection of radioactive technetium 99Tcm carried on tilmanocept (Lymphoseek ®) at the tumour site. The radioactivity in the lymph node is then visualized preoperatively with Single Photon Emission Computed Tomography (SPECT/CT). Intraoperatively, indocyanine green (ICG) is injected and a sentinel node is visualized with near-infrared light. To support the sentinel node detection, the surgeon uses a hand-held gamma detection probe. This approach results in a reproducible and reliable detection of sentinel nodes.

Conclusion: This paper presents a novel protocol for the identification of the sentinel node in the head and neck region. The protocol additionally enables the use of flow cytometry analysis of resected lymph nodes.

Keywords: Sentinel lymph node biopsy (SLNB), oral squamous cell carcinoma (OSCC), head and neck cancer, elective neck dissection, flow cytometry, tilmanocept.

Cabanas RM. An approach for the treatment of penile carcinoma. Cancer 1977; 39(2): 456-66.
[<456:AID-CNCR2820390214>3.0.CO;2-I] [PMID: 837331]
Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol 2010; 11(10): 927-33.
[] [PMID: 20863759]
Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med 2006; 355(13): 1307-17.
[] [PMID: 17005948]
Schilling C, Stoeckli SJ, Vigili MG, et al. Surgical consensus guidelines on sentinel node biopsy (SNB) in patients with oral cancer. Head Neck 2019; 41(8): 2655-64.
[] [PMID: 30896058]
Schilling C, Stoeckli SJ, Haerle SK, et al. Sentinel European Node Trial (SENT): 3-year results of sentinel node biopsy in oral cancer. Eur J Cancer 2015; 51(18): 2777-84.
[] [PMID: 26597442]
Agrawal A, Civantos FJ, Brumund KT, et al. [(99m)Tc] Tilmanocept Accurately Detects Sentinel Lymph Nodes and Predicts Node Pathology Status in Patients with Oral Squamous Cell Carcinoma of the Head and Neck: Results of a Phase III Multi-institutional Trial. Ann Surg Oncol 2015; 22(11): 3708-15.
[] [PMID: 25670018]
Outh-Gauer S, Alt M, Le Tourneau C, et al. Immunotherapy in head and neck cancers: A new challenge for immunologists, pathologists and clinicians. Cancer Treat Rev 2018; 65: 54-64.
[] [PMID: 29547766]
Zolkind P, Uppaluri R. Checkpoint immunotherapy in head and neck cancers. Cancer Metastasis Rev 2017; 36(3): 475-89.
[] [PMID: 28836124]
Häyry V, Kågedal Å, Hjalmarsson E, et al. Rapid nodal staging of head and neck cancer surgical specimens with flow cytometric analysis. Br J Cancer 2018; 118(3): 421-7.
[] [PMID: 29161240]
Peek MC, Kovacs T, Baker R, Hamed H, Kothari A, Douek M. Is blue dye still required during sentinel lymph node biopsy for breast cancer? Ecancermedicalscience 2016; 10: 674.
[] [PMID: 27729939]
Hackethal A, Hirschburger M, Eicker SO, Mücke T, Lindner C, Buchweitz O. Role of Indocyanine Green in Fluorescence Imaging with Near-Infrared Light to Identify Sentinel Lymph Nodes, Lymphatic Vessels and Pathways Prior to Surgery - A Critical Evaluation of Options. Geburtshilfe Frauenheilkd 2018; 78(1): 54-62.
[] [PMID: 29375146]
KleinJan GH, Bunschoten A, van den Berg NS, et al. Fluorescence guided surgery and tracer-dose, fact or fiction? Eur J Nucl Med Mol Imaging 2016; 43(10): 1857-67.
[] [PMID: 27020580]
Yuasa Y, Seike J, Yoshida T, et al. Sentinel lymph node biopsy using intraoperative indocyanine green fluorescence imaging navigated with preoperative CT lymphography for superficial esophageal cancer. Ann Surg Oncol 2012; 19(2): 486-93.
[] [PMID: 21792510]
Polom K, Murawa D, Rho YS, Nowaczyk P, Hünerbein M, Murawa P. Current trends and emerging future of indocyanine green usage in surgery and oncology: a literature review. Cancer 2011; 117(21): 4812-22.
[] [PMID: 21484779]
Surasi DS, O’Malley J, Bhambhvani P. 99mTc-Tilmanocept: A Novel Molecular Agent for Lymphatic Mapping and Sentinel Lymph Node Localization J Nucl Med Technol 2015; 43(21): 87- 91.
KleinJan GH, van Werkhoven E, van den Berg NS, et al. The best of both worlds: a hybrid approach for optimal pre- and intraoperative identification of sentinel lymph nodes. Eur J Nucl Med Mol Imaging 2018; 45(11): 1915-25.
[] [PMID: 29696442]
de Veij Mestdagh PD, Jonker MCJ, Vogel WV, et al. SPECT/CT-guided lymph drainage mapping for the planning of unilateral elective nodal irradiation in head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol 2018; 275(8): 2135-44.
[] [PMID: 29955968]
Vera DR, Wallace AM, Hoh CK, Mattrey RF. A synthetic macromolecule for sentinel node detection: (99m)Tc-DTPA-mannosyl-dextran. J Nucl Med 2001; 42(6): 951-9.
[PMID: 11390562]
Tokin CA, Cope FO, Metz WL, et al. The efficacy of Tilmanocept in sentinel lymph mode mapping and identification in breast cancer patients: a comparative review and meta-analysis of the 99mTc-labeled nanocolloid human serum albumin standard of care. Clin Exp Metastasis 2012; 29(7): 681-6.
[] [PMID: 22729510]
Grischke E-M, Röhm C, Hahn M, Helms G, Brucker S, Wallwiener D. ICG Fluorescence Technique for the Detection of Sentinel Lymph Nodes in Breast Cancer: Results of a Prospective Open-label Clinical Trial. Geburtshilfe Frauenheilkd 2015; 75(9): 935-40.
[] [PMID: 26500370]
Huang S-F, Kang C-J, Lin C-Y, et al. Neck treatment of patients with early stage oral tongue cancer: comparison between observation, supraomohyoid dissection, and extended dissection. Cancer 2008; 112(5): 1066-75.
[] [PMID: 18246535]
Kamali A, Gahm C, Palmgren B, Marklund L, Halle M, Hammarstedt-Nordenvall L. Regional recurrence in early stage I-II oral tongue cancer: a single institutional study and review of the literature. Acta Otolaryngol 2017; 137(7): 755-61.
[] [PMID: 28361597]
Broglie MA, Haerle SK, Huber GF, Haile SR, Stoeckli SJ. Occult metastases detected by sentinel node biopsy in patients with early oral and oropharyngeal squamous cell carcinomas: impact on survival. Head Neck 2013; 35(5): 660-6.
[] [PMID: 22605675]

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