Intra-operative lymphatic mapping and sentinel node biopsy in laryngeal carcinoma using radiotracer injection

• Published in: Annals of nuclear medicine Vol. 38; no. 10; pp. 795 - 801
• Main Authors: Sahafi, Pegah, Saber Tanha, Amin, Daghighi, Maryam, Khadivi, Ehsan, Khazaeni, Kamran, Vahid Reza, Dabbagh Kakhki, Sadeghi, Ramin
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.10.2024; Springer Nature B.V
• Subjects: Anesthesia; Biopsy; Cancer; Feasibility; Glottis; Imaging; Laryngeal carcinoma; Laryngoscopy; Larynx; Lymph nodes; Lymphatic system; Medical instruments; Medicine; Medicine & Public Health; Nuclear Medicine; Original Article; Radioactive tracers; Radiology; Squamous cell carcinoma; Tumors; Nuclear medicine; Squamous cell carcinoma; Larynx; Sentinel lymph node; Laryngeal SCC
• ISSN: 0914-7187; 1864-6433; 1864-6433
• DOI: 10.1007/s12149-024-01948-y

Objective The purpose of this study was to determine the value of sentinel lymph node biopsy (SLNB) in the laryngeal SCC, using intra-operative peri-tumoral injection of Tc-99m-phytate. Methods Patients with biopsy-proven squamous cell carcinoma of the larynx were included. On the day of surgery, after anesthesia induction, suspension laryngoscopy was performed to inject 74 MBq/0.4 ml Tc-99m-phytate in four aliquots into the sub-mucosal peri-tumoral location. After a 10-min wait, a portable gamma probe was used to locate sentinel nodes. Subsequently, all patients underwent laryngectomy and neck dissection. Both sentinel nodes and non-sentinel nodes were examined using hematoxylin and eosin (H&E) staining. Results Twenty-six patients with a diagnosis of laryngeal carcinoma were included in the study. The SLN detection rate was 65.4%, with a 100% detection rate in the supraglottic region and a 52.6% detection rate for glottis/transglottic patients. Permanent pathology results showed lymph node involvement in four patients, but only one patient had a negative result in the SLNB, resulting in an overall false negative rate of 25%. The sensitivity of the SLN technique was 75% overall, 100% in the supraglottic region, and 67% in the glottis/transglottic region. Conclusion The accuracy and feasibility of SLNB may be related to the location of the tumors in the larynx. For supraglottic tumors, the technique seems to be feasible with a low false negative rate. For glottis/transglottic tumors, both the detection rate and false negative rate seem to be suboptimal. Further studies are needed to validate our results.