lymphoscintigraphy in head and neck skin cancers: an atlas
TRANSCRIPT
e-mail: [email protected]
4th International Sentinel Node CongressDecember 3 - 6, 2004
Santa Monica, CA USA
Introduction: The lymphatic system of the
head and neck consists of complex networks
of collecting vessels and about 300 nodes
(1/5 of the total body nodes). The valves in
these vessels are more numerous than those
in the lower limbs. This anatomical
characteristic together with the effect of
gravity favours a more rapid lymph flow in
the head and neck. A dynamic or early static
lympho scintigraphy is a reliable method of
identifying the Sentinel Nodes (SN) in head
and neck skin cancers.
Methods: Between Nov. ’99 and April 2004
55 patients (34m, 21f) with head and neck
skin cancers were enrolled on our study. 37
melanoma cT2-3N0, 14 with Lip Squamous
Cell Carcinoma (SCC) cT2N0 and 4 patients
with Merkel disease. 30-50 MBq of 99mTc-
Albumin-Nanocoll, diluted in 0.3 mL was
injected intradermally, into two perilesional
points. A planar static scintigraphy was
acquired immediately after the injection
visualising the lymph drainage pathways. A
SN radioguided biopsy was performed three
hours after lymphscintigraphy.
Results: SNs were observed on the I-II
Neck Level (NL) within 5 minutes of the
injection in 20 patient; 14 cases of cheek
tumour, 4 nose cancers and 2 tumours on
the eyelids. In 14/15 patients with SCC on
the lip the SNs were detected on Ia-Ib NL.
In 5 up to 7 patients with ear localisation
SNs were detected in the pre-auricular
region and in 2 patients on NL II. In the 7
patients with parieto temporal localisation
the SNs in 3 cases were detected in the
retroauricolar region, in 2 cases in the
occipital region and in 2 cases on the IV-V
NL. In 1 patient with melanoma of frontal
region, 2 SNs were detected in the bilateral
retroauricolar region, and 1 SN on NL IV.
In 5 patients with a neck tumour the lymph
drainage was observed in all directions,
including the cranial direction. Pathologic
upstaging of the clinically N0 neck occurred
in 7 (13%) of 55 patients.
Conclusion: The unpredictability of
lymphatic drainage in head and neck skin
cancers depends strongly on the tumour site.
By using nanocolloids were observed that
the radioactivity of the first sentinel node
decreases quickly and therefore we
recommend a short interval between
scintigraphy and a radioguided biopsy no
more than 3 hours.
Lymphoscintigraphy in Head and Neck Skin Cancers: An Atlas of Sentinel Node Mapping
Girolamo Tartaglione, M.D. *, Clemente Potenza, M.D. **, Alessio Caggiati, M.D. **, Marino Maggiore. M.D. **, Marco Pagan, M.D.
* Department of Nuclear Medicine, Cristo Re Hospital, Rome, Italy ** Department of Plastic Surgery, IDI IRCCS, Rome, Italy
SN 2004 Poster No. 134
5 min 10 min
Melanoma T2a - Right Cheek
2 SNs- on Ib NLR
Melanoma T1b - Right Cheek
2 SNs- on Ia NLR
Merkel Disease - Right Cheek
2 SNs+ on Ib NLR
Melanoma T2 - Right Cheek
1 SN- on Ib NLR
Melanoma T2a - Right Cheek
1 SN- on Ib NLR , 1SN- on II NLR
Melanoma T2a - Right Cheek
1 SN- on II NLR, 1 SN- Parotid RMelanoma T2 - Right Cheek
2 SNs- on I NLR
Melanoma T - Left Cheek
1 SN- V NLL
Melanoma T1b - Right Cheek
1 SN- on Ib NLR
Melanoma T3 - Right Cheek
2 SN+ on I NLR
Melanoma T1b - Left Cheek
2 SNs- on I NLL
Melanoma T4a - Right Cheek
1 SN+ on I NLR, 1 SN on IV NLR
Melanoma T3a - Right Cheek
2 SN- on I NLR, 1 SN- on IV NLR
Melanoma T2a - Right Cheek
1 SN- on Ib NLR
Melanoma T4a - Left Nose
2 SN- on I NLL
Merkel Disease - Left Sup Eyelid
1 SN- on Ib NLL
Melanoma T3 - Occipital
1 SN+ Occipital
Melanoma T3 - Right Inf Eyelid
1 SN+ on II NLR
Melanoma T4a - Right Nose
1 SN- on I NLR
Melanoma - Right Nose
1 SN- on Ib NLR
Melanoma - Right Nose
1 SN- on I NLR, 1 SN- II NLR
SCC T2N – Lower Lip
3 SNs- on I NLL
SCC T2 - Right Lip Commissure
1 SN- on I NLR
SCC T2 - Right Lower Lip
1 SN- on I NLR , 1 SN- II NLR
SCC T2- Right Lower Lip
2 SN- on I NLR, 1 SN- on II NLR
(same pt) SCC T2 - Right Lower Lip
2 SN- on I NLR, 1 SN- on II NLR
SCC T2 - Left Lower Lip
1 SN- on I NLL
(same pt) SCC T2 - Left Lower Lip
1 SN- on I NLL (ant view)
SCC T2 - Left Lower Lip cT2
1 SN- on I NLL
SCC T2 - Right Lower Lip
2 SNs- on I NLRSCC T2 – Right Upper Lip
1 SN- on I NLR
SCC T2 - Right Lip Commissure
1 SN- I NLR, 1 SN II NLR
SCC T2 - Left Lower Lip
1 SN- I NLL, 1 SN- II NLL
SCC T2 - Right Lip Commissure
2 SNs- on I NLR
SCC cT2N0 - Upper Left Lip
1 SN- Ia NLL
Merkel Disease of Upper Lip
1 SN+ on I NLL
(same pt) Merkel Disease of Upper Lip
1 SN+ on I NLL (ant view)
SCC T2 - Left Lip Commissure
2 SNs- I NLL, 1 SN- V NLL
SCC T2 - Upper Lip
1 SN- Ia NL
(same pt) SCC T2 - Upper Left Lip
1 SN- on I NLL (Lat view)
Melanoma T2a of Right Ear
1SN- II NLR , 1 SN- on IV NLR
Melanoma T3a of Left Ear
1 SN- Ib NLL, 1 SN- IV NLL
Melanoma T1b - Parietal
1 SN- V NLL (2 SN- retroauricolar R & L)
SCC T2- Left Lower Lip
1 SN- on I NLL
Melanoma - Right Ear
1 SN- II NLR
Melanoma T2a - Right Ear
1SN- on Retroauricolar R
Melanoma T1a - Right Ear
1SN- on Ib NLR
Melanoma T3a Left Ear
1SN- on Ib NLL , 1 SN- on IV NLL
Melanoma T2a - Left Ear
1SN+ on II NLL, 1 SN on IV NLL
(same pt.) Melanoma T1b - Parietal
2 SNs- on Retroauricolar L (& R) ,1 SN- V NLR
Melanoma T1a - Right Parietal
1 SN- on Retroauricolar R, 1 SN- IV NLR Melanoma T2a - Left Parietal
1 SN- on II NL Left
Melanoma T2a - Left Occipital
1 SN- on Occipital L
Melanoma T3a Parietal R
2 SNs- on I NLR, (1 SN- on IV NLL)
Merkel Disease - Left Parietal
2 SN- on Ib NLL, 1 SN- on Left Parotid
Melanoma T1b - Frontal
1 SN- on Occipital, 1 SN- on II NLR,
1SN- on II NLL
(same pt) Melanoma T1b – Right Frontal
1 SN- on Occipital, 1SN- on II NLR,
1SN- on II NLL
Melanoma T3a - Left Neck
3 SNs- on I, IV, V NLL
Melanoma T2a - Left Neck
4 SN- on IV,V NLL
Melanoma T1a - Left Neck
1 SN- on V NLL
Melanoma T2a - Right Neck
1 SN- on I NLR
Melanoma T3a - Right Neck
1 SN on II NLR, 1 SN on IV NLR
(same pt) Melanoma T3a - Right Neck
1 SN on II NLR, 1 SN on IV NLR
R