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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 3/2019

Open Access 01-03-2019 | Guidelines

The EANM practical guidelines for sentinel lymph node localisation in oral cavity squamous cell carcinoma

Authors: Francesco Giammarile, Clare Schilling, Gopinanth Gnanasegaran, Chandrasckhar Bal, Wim J. G. Oyen, Domenico Rubello, Thomas Schwarz, Girolamo Tartaglione, Rodolfo Nuñez Miller, Diana Paez, Fijis W. B. van Leeuwen, Renato A. Valdés Olmos, Mark McGurk, Roberto C. Delgado Bolton

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 3/2019

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Abstract

Purpose

Sentinel lymph node biopsy is an essential staging tool in patients with clinically localized oral cavity squamous cell carcinoma. The harvesting of a sentinel lymph node entails a sequence of procedures with participation of specialists in nuclear medicine, radiology, surgery, and pathology. The aim of this document is to provide guidelines for nuclear medicine physicians performing lymphoscintigraphy for sentinel lymph node detection in patients with early N0 oral cavity squamous cell carcinoma.

Methods

These practice guidelines were written and have been approved by the European Association of Nuclear Medicine (EANM) and the International Atomic Energy Agency (IAEA) to promote high-quality lymphoscintigraphy. The final result has been discussed by distinguished experts from the EANM Oncology Committee, and national nuclear medicine societies. The document has been endorsed by the Society of Nuclear Medicine and Molecular Imaging (SNMMI).
These guidelines, together with another two focused on Surgery and Pathology (and published in specialised journals), are part of the synergistic efforts developed in preparation for the “2018 Sentinel Node Biopsy in Head and Neck Consensus Conference”.

Conclusion

The present practice guidelines will help nuclear medicine practitioners play their essential role in providing high-quality lymphatic mapping for the care of early N0 oral cavity squamous cell carcinoma patients.
Literature
1.
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics 2002. CA Cancer J Clin. 2005;55:74–108.CrossRefPubMed
2.
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global Cancer statistics. CA Cancer J Clin. 2011;61:69–90.CrossRefPubMed
3.
Pitman KT, Johnson JT, Myers EN. Effectiveness of selective neck dissection for management of the clinically negative neck. Arch Otolaryngol Head Neck Surg. 1997;123:917–22.CrossRefPubMed
4.
Shah JP, Candela FC, Poddar AK. The patterns of cervical lymph node metastases from squamous carcinoma of the oral cavity. Cancer. 1990;66:109–13.CrossRefPubMed
5.
Spiro JD, Spiro RH, Shah JP, Sessions RB, Strong EW. Critical assessment of supraomohyoid dissection. Am J Surg. 1988;156:286–9.CrossRefPubMed
6.
Gourin CG, Conger BT, Porubsky ES, Sheils WC, Bilodeau PA, Coleman TA. The effect of occult nodal metastases on survival and regional control in patients with head and neck squamous cell carcinoma. Laryngoscope. 2008;118:1191–4.CrossRefPubMed
7.
Don DM, Anzai Y, Lufkin RB, Fu YS, Calcaterra TC. Evaluation of cervical lymph node metastasis in squamous carcinoma of the head and neck. Laryngoscope. 1995;105:669–74.CrossRefPubMed
8.
Leemans CR, Tiwari R, Van der Waal I, Karim AB, Nauta JJ, Snow GB. The efficacy of comprehensive neck dissection with or without postoperative radiotherapy in nodal metastases of squamous cell carcinoma of the upper respiratory and digestive tracts. Laryngoscope. 1990;100:1194–8.CrossRefPubMed
9.
Ambrosch P, Kron M, Fischer G, Brinck U. Micrometastases in carcinoma of the upper aerodigestive tract: detection, risk of metastasizing, and prognostic value of depth of invasion. Head Neck. 1995;17:473–9.CrossRefPubMed
10.
Kane SV, Gupta M, Kakade AC, D’Cruz A. Depth of invasion is the most significant histological predictor of subclinical cervical lymph node metastasis in early squamous carcinomas of the oral cavity. Eur J Surg Oncol. 2006;32:795–803.CrossRefPubMed
11.
Pimenta Amaral TM, Da Silva Freire AR, Carvalho AL, Pinto CA, Kowalski LP. Predictive factors of occult metastasis and prognosis of clinical stages I and II squamous cell carcinoma of the tongue and floor of the mouth. Oral Oncol. 2004;40:780–6.CrossRefPubMed
12.
Yamamoto E, Miyakawa A, Kohama G. Mode of invasion and lymph node metastasis in squamous cell carcinoma of the oral cavity. Head Neck Surg. 1984;6:938–47.CrossRefPubMed
13.
Alkureishi LW, Ross GL, Shoaib T, Soutar DS, Robertson AG, Sorensen JA, et al. Does tumour depth affect nodal staging in squamous cell carcinoma of the head and neck. Laryngoscope. 2008;118:629–34.CrossRefPubMed
14.
Goerkem M, Braun J, Stoeckli SJ. Evaluation of clinical and histomorphological parameters as potential predictors of occult metastases in sentinel lymph nodes of early squamous cell carcinomas of the oral cavity. Ann Surg Oncol. 2010;17:527–35.CrossRefPubMed
15.
D’Cruz AK, Vaish R, Kapre N, Dandekar M, Gupta S, Hawaldar R, et al. Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med. 2015;373:521–9.CrossRefPubMed
16.
Inoue H, Nibu K, Saito M, Otsuki N, Ishida H, Onitsuka T, et al. Quality of life after neck dissection. Arch Otolaryngol Head Neck Surg. 2006;132:662–6.CrossRefPubMed
17.
Ganly I, Goldstein D, Carlson DL, Patel SG, O’Sullivan B, Lee N, et al. Long-term regional control and survival in patients with “low-risk”, early stage oral tongue cancer managed by partial glossectomy and neck dissection without postoperative radiation. Cancer. 2013;119:1168–76.CrossRefPubMed
18.
Byers RM. Modified neck dissection: a study of 967 cases from 1970 to 1980. Am J Surg. 1985;150:414–21.CrossRefPubMed
19.
Byers RM, Wolf PF, Ballantyne AJ. Rationale for elective modified neck dissection. Head Neck Surg. 1988;10:160–7.CrossRefPubMed
20.
Shah JP. Cervical lymph node metastases—diagnostic, therapeutic and prognostic implications. Oncology. 1990;4:61–9.PubMed
21.
Shah JP, Andersen PE. Evolving role of modifications in neck dissection for oral squamous carcinoma. Br J Oral Maxillofac Surg. 1995;33:3–8.CrossRefPubMed
22.
Brazilian Head and Neck Cancer Study Group. Results of a prospective trial on elective modified radical classical versus supraomohyoid neck dissection in the management of oral squamous carcinoma. Am J Surg. 1998;176:422–6.CrossRef
23.
24.
Cheng A, Schmidt BL. Management of the N0 neck in oral squamous cell carcinoma. Oral Maxillofac Surg Clin North Am. 2008;20:477–97.CrossRefPubMed
25.
Lindberg R. Distribution of cervical lymph node metastases from squamous cell carcinoma of the upper respiratory and digestive tracts. Cancer. 1972;29:1446–9.CrossRefPubMed
26.
Byers RM, Clayman GL, McGill D, Andrews T, Kare RP, Roberts DB, et al. Selective neck dissection for squamous carcinoma of the upper aerodigestive tract: patterns of regional failure. Head Neck. 1999;21:499–505.CrossRefPubMed
27.
Jeong HS, Jones D, Liao S, Wattson DA, Cui CH, Duda DG, et al. Investigation of the lack of angiogenesis in the formation of lymph node metastases. J Natl Cancer Inst. 2015;107:pii: djv155.CrossRef
28.
Van Den Berg NS, Buckle T, Kleinjan GI, Klop WM, Horenblas S, Van Der Poel HG, et al. Hybrid tracers for sentinel node biopsy. Q J Nucl Med Mol Imaging. 2014;58:193–206.
29.
Álvarez Amézaga J, Barbier Herrero L, Pijoan del Barrio JI, Martín Rodríguez JC, Romo Simón L, Genolla Subirats J, et al. Diagnostic efficacy of sentinel node biopsy in oral squamous cell carcinoma. Cohort study and meta-analysis. Med Oral Patol Oral Cir Bucal. 2007;12:E235–43.PubMed
30.
Burcia V, Costes V, Faillie JL, Gardiner Q, de Verbizier D, Cartier C, et al. Neck restaging with sentinel node biopsy in T1-T2N0 oral and oropharyngeal cancer: why and how? Otolaryngol Head Neck Surg. 2010;142:592–7.CrossRefPubMed
31.
Civantos FJ, Zitsch RP, Schuller DE, Agrawal A, Smith RB, Nason R, et al. Sentinel lymph node biopsy accurately stages the regional lymph nodes for T1-T2 oral squamous cell carcinomas: results of a prospective multi-institutional trial. J Clin Oncol. 2010;28:1395–400.CrossRefPubMedPubMedCentral
32.
Govers TM, Hannink G, Merkx MA Takes RP, Rovers MM. Sentinel node biopsy for squamous cell carcinoma of the oral cavity and oropharynx: a diagnostic meta-analysis. Oral Oncol. 2013;49:726–32.CrossRefPubMed
33.
Schilling C, Stoeckli SJ, Haerle SK, Broglie MA, Huber GF, Sorensen JA, et al. Sentinel European Node Trial (SENT): 3-year results of sentinel node biopsy in oral cancer. Eur J Cancer. 2015;51:2777–84.CrossRefPubMed
34.
Farmer RW, McCall L, Civantos FJ, Myers JN, Yarbrough WG, Murphy B, et al. Lymphatic drainage patterns in oral squamous cell carcinoma: findings of the ACOSOG Z0360 (Alliance) study. Otolaryngol Head Neck Surg. 2015;152:673–7.CrossRefPubMedPubMedCentral
35.
Sundermann BV, Uhlmann L, Hoffmann J, Freier K, Thiele OC. The localization and risk factors of squamous cell carcinoma in the oral cavity: a retrospective study of 1501 cases. J Craniomaxillofac Surg. 2018;46:177–82.CrossRefPubMed
36.
Wheless SA, McKinney KA, Zanation AM. A prospective study of the clinical impact of a multidisciplinary head and neck tumor board. Otolaryngol Head Neck Surg. 2010;143:650–4.CrossRefPubMedPubMedCentral
37.
Nieweg OE, Estourgie S, Valdés Olmos RA. Lymphatic mapping and sentinel node biopsy. In: Ell PJ, Gambhir SS, editors. Nuclear medicine in clinical diagnosis and treatment. 3rd ed. Edinburgh: Churchill Livingstone; 2004. p. 229–60.
38.
Alazraki N, Glass EC, Castronovo F, Valdés Olmos RA, Podoloff D. Procedure guideline for lymphoscintigraphy and the use of intraoperative gamma probe for sentinel lymph node localisation in melanoma of intermediate thickness 1.0. J Nucl Med. 2002;43:1414–8.PubMed
39.
Tartaglione G, Stoeckli SJ, de Bree R, Schilling C, Flach GB, Bakholdt V, et al. Sentinel node in oral cancer: the nuclear medicine aspects. A survey from the Sentinel European Node Trial. Clin Nucl Med. 2016;41:534–42.CrossRefPubMed
40.
Buckle T, KleinJan GH, Engelen T, van den Berg NS, DeRuiter MC, van der Heide U, et al. Diffusion-weighted-preparation (D-prep) MRI as a future extension of SPECT/CT based surgical planning for sentinel node procedures in the head and neck area? Oral Oncol. 2016;60:48–54.CrossRefPubMed
41.
Som PM, Curtin HD, Mancuso AA. The new imaging-based classification for describing the location of lymph nodes in the neck with particular regard to cervical lymph nodes in relation to cancer of the larynx. RL J Otorhinolaryngol Relat Spec. 2000;62:186–98.CrossRef
42.
Robbins KT, Shaha AR, Medina JE, Califano JA, Wolf GT, Ferlito A, Som PM, Day TA, Committee for Neck Dissection Classification, American Head and Neck Society. Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg. 2008;134:536–8.CrossRefPubMed
43.
Giammarile F, Alazraki N, Aarsvold JN, Audisio RA, Glass E, Grant SF, et al. The EANM and SNMMI practice guideline for lymphoscintigraphy and sentinel node localization in breast cancer. Eur J Nucl Med Mol Imaging. 2013;40:1932–47.CrossRefPubMed
44.
Bluemel C, Herrmann K, Giammarile F, Nieweg OE, Dubreuil J, Testori A, et al. EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma. Eur J Nucl Med Mol Imaging. 2015;42:1750–66.CrossRefPubMed
45.
Alkureishi LW, Burak Z, Alvarez JA, Ballinger J, Bilde A, Britten AJ, et al. Joint practice guidelines for radionuclide lymphoscintigraphy for sentinel node localization in oral/oropharyngeal squamous cell carcinoma. Eur J Nucl Med Mol Imaging. 2009;36:1915–36.CrossRefPubMedPubMedCentral
46.
Heuveling DA, Karagozoglu KH, Van Lingen A, Hoekstra OS, Van Dongen GAMS, De Bree R. Feasibility of intraoperative detection of sentinel lymph nodes with 89-zirconium-labelled nanocolloidal albumin PET-CT and a handheld high-energy gamma probe. EJNMMI Res. 2018;8:15.CrossRefPubMedPubMedCentral
47.
Bunschoten A, van den Berg NS, Valdés Olmos RA, Blokland JAK, van Leeuwen FWB. Tracers applied in radioguided surgery. In: Herrmann K, Nieweg OE, Povoski SP, editors. Radioguided surgery — current applications and innovation directions in clinical practice. 1st ed. Berlin Heidelberg: Springer-Verlag; 2016. p. 75–101.
48.
Strzelczyk I, Finlayson C. Sentinel node biopsy: ALARA and other considerations. Health Phys. 2004;86(suppl. 2):S31–4.CrossRefPubMed
49.
Law M, Ma WH, Leung R, Li S, Wong KK, Ho WY, et al. Evaluation of patient effective dose from sentinel lymph node lymphoscintigraphy in breast cancer: a phantom study with SPECT/CT and ICRP-103 recommendations. Eur J Radiol. 2012;81:e717–20.CrossRefPubMed
50.
Keshtgar MRS, Waddington WA, Lakhari SK, Ell PJ. Dosimetry and radiation protection. The sentinel node in surgical oncology. 1st ed. Berlin Heidelberg: Springer-Verlag; 1999. p. 91–101.CrossRef
51.
Pandit-Taskar NN, Dauer LT, Montgomery L, St Germain J, Zanzonico PB, Divgi CR. Organ and fetal absorbed dose estimates from Tc-99m-sulfur colloid lymphoscintigraphy and sentinel node localization in breast cancer patients. J Nucl Med. 2006;47:1202–8.PubMed
52.
McCollough CH, Bushberg JT, Fletcher JG, Eckel LJ. Answers to common questions about the use and safety of CT scans. Mayo Clin Proc. 2015;90:1380–92.CrossRefPubMed
53.
ICRP. Pregnancy and medical radiation. International commission on radiological protection. ICRP publication no. 84. Ann ICRP. 2000;30:1–43.
54.
Specific Safety Guide. Radiation protection and safety in medical uses of ionizing radiation. IAEA Safety Standards Series No. SSG-46, 2018.
55.
Sera T, Mohos G, Papos M, Osvay M, Varga J, Lazar M, et al. Sentinel node detection in malignant melanoma patients: radiation safety considerations. Dermatol Surg. 2003;29:141–5.PubMed
56.
Stratmann SL, McCarthy TM, Kuhn JA. Radiation safety with breast sentinel node biopsy. Am J Surg. 1999;25:196–202.
57.
Klausen TL, Chakera AH, Friis E, Rank F, Hesse B, Holm S. Radiation doses to staff involved in sentinel node operations for breast cancer. Clin Physiol Funct Imaging. 2005;25:196–202.CrossRefPubMed
58.
Glass EC, Basinski JE, Krashne DL, Guiliano AE. Radiation safety considerations for sentinel node techniques. Ann Surg Oncol. 1999;6:10–1.CrossRefPubMed
59.
IAEA. Nuclear medicine resources manual. Chapter 8: Radiation safety practice in nuclear medicine. Vienna: IAEA; 2006. 509–21.
60.
Nugent N, Hill AD, Casey M, Kelly L, Dijkstra B, Collins CD, et al. Safety guidelines for radiolocalised sentinel node resection. Ir J Med Sci. 2001;170:236–8.CrossRefPubMed
61.
Waddington WA, Keshtgar MRS, Taylor I, Lakhani SR, Short MD, Ell PJ. Radiation safety of the sentinel node technique in breast cancer. Eur J Nucl Med. 2000;27:377–91.CrossRefPubMed
62.
KleinJan GH, van Werkhoven E, van den Berg NS, Karakullukcu MB, Zijlmans HJMAA, van der Hage JA, 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;45:1915–25.CrossRefPubMedPubMedCentral
63.
Valdés Olmos RA, Vidal-Sicart S, Manca G, Mariani G, León-Ramírez LF, Rubello D, et al. Advances in radioguided surgery in oncology. Q J Nucl Med Mol Imaging. 2017;61:247–70.PubMed
64.
Van den Berg NS, Brower OR, Schaafsma BE, Mathéron HM, Klop WM, Balm AJ, et al. Multimodal surgical guidance during sentinel node biopsy for melanoma: combined gamma tracing and fluorescence imaging of the sentinel node through use of the hybrid tracer indocyanine green-(99m)Tc-nanocolloid. Radiology. 2015;275:521–9.CrossRefPubMed
65.
Van den Berg NS, Brower OR, Klop WM, Karakullukcu B, Zuur CL, Tan IB, et al. Concomitant radio- and fluorescence-guided sentinel lymph node biopsy in squamous cell carcinoma of the oral cavity using ICG-(99m)Tc-nanocolloid. Eur J Nucl Med Mol Imaging. 2012;39:1128–36.CrossRefPubMed
66.
Van den Berg NS, Miwa M, KleinJan GH, Sato T, Maeda Y, van Akkooi AC, et al. (Near-infrared) fluorescence-guided surgery under ambient light conditions: a next step to embedment of the technology in clinical routine. Ann Surg Oncol. 2016;23:2586–95.CrossRefPubMedPubMedCentral
67.
68.
Flach GB, Bloemena E, van Schie A, Hoekstra OS, van Weert S, Leemans CR, et al. Sentinel node identification in laryngeal cancer: feasible in primary cancer with previously untreated neck. Oral Oncol. 2013;49:165–8.CrossRefPubMed
69.
Jadhav KB, Gupta N. Clinicopathological prognostic implicators of oral squamous cell carcinoma: need to understand and revise. N Am J Med Sci. 2013;5:671–9.CrossRefPubMedPubMedCentral
Metadata
Title
The EANM practical guidelines for sentinel lymph node localisation in oral cavity squamous cell carcinoma
Authors
Francesco Giammarile
Clare Schilling
Gopinanth Gnanasegaran
Chandrasckhar Bal
Wim J. G. Oyen
Domenico Rubello
Thomas Schwarz
Girolamo Tartaglione
Rodolfo Nuñez Miller
Diana Paez
Fijis W. B. van Leeuwen
Renato A. Valdés Olmos
Mark McGurk
Roberto C. Delgado Bolton
Publication date
01-03-2019
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 3/2019
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-018-4235-5

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