Ingo Stoffels1,2,3, Julia Leyh1,2,3, Thorsten Pöppel4, Dirk Schadendorf1,2,3, Joachim Klode5,6,7. 1. Department of Dermatology, Venerology and Allergology, University Hospital Essen University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany. 2. West German Cancer Center, University Duisburg-Essen, Essen, Germany. 3. German Cancer Consortium (DKTK), Essen, Germany. 4. Department of Nuclear Medicine, University Hospital Essen University of Duisburg-Essen, Essen, Germany. 5. Department of Dermatology, Venerology and Allergology, University Hospital Essen University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany. joachim.klode@uk-essen.de. 6. West German Cancer Center, University Duisburg-Essen, Essen, Germany. joachim.klode@uk-essen.de. 7. German Cancer Consortium (DKTK), Essen, Germany. joachim.klode@uk-essen.de.
Abstract
PURPOSE: There is some controversy about the value of sentinel lymph node excision (SLNE) in patients with head and neck malignancies. The gold standard for detection and targeted extirpation of the SLN is lymphoscintigraphy with (99m)Tc-nanocolloid. The purpose of this prospective randomized study was to analyse the feasibility and clinical benefit of a hybrid tracer comprising the near-infrared (NIR) fluorescent indocyanine green (ICG) and (99m)Tc-nanocolloid (ICG-(99m)Tc-nanocolloid) in direct comparison with standard (99m)Tc-nanocolloid for guiding SLNE in patients with head and neck cutaneous malignancies. METHODS: We analysed the data from 40 clinically lymph node-negative patients with melanoma, high-risk cutaneous squamous cell carcinoma, Merkel cell carcinoma or sweat gland carcinoma who underwent SLNE with ICG-(99m)Tc-nanocolloid (cohort A) or with the standard (99m)Tc-nanocolloid (cohort B). RESULTS:Overall SLNs were identified preoperatively in all 20 patients (100%) in cohort A and in 18 of 20 patients (90%) in cohort B. The SLN basin was detected preoperatively in 18 patients (90%) in cohort A and also in 18 patients (90%) in cohort B. SLNs were identified intraoperatively in all 20 patients (100%) in cohort A and in 19 patients (95%) in cohort B (p = 0.487). Metastatic SLNs were detected in 9 patients (22.5%), 3 (15.0%) in cohort A and 6 (30.0%) in cohort B (p = 0.228). CONCLUSION: The hybrid tracer ICG-(99m)Tc-nanocolloid is an innovative imaging tracer, reliably and readily providing additional information for the detection and excision of SLN in the head and neck region. Therefore, SLNE with combined radioactive and NIR fluorescence guidance is an attractive option for improving the SLN detection rate in patients with cutaneous head and neck malignancies.
RCT Entities:
PURPOSE: There is some controversy about the value of sentinel lymph node excision (SLNE) in patients with head and neck malignancies. The gold standard for detection and targeted extirpation of the SLN is lymphoscintigraphy with (99m)Tc-nanocolloid. The purpose of this prospective randomized study was to analyse the feasibility and clinical benefit of a hybrid tracer comprising the near-infrared (NIR) fluorescent indocyanine green (ICG) and (99m)Tc-nanocolloid (ICG-(99m)Tc-nanocolloid) in direct comparison with standard (99m)Tc-nanocolloid for guiding SLNE in patients with head and neck cutaneous malignancies. METHODS: We analysed the data from 40 clinically lymph node-negative patients with melanoma, high-risk cutaneous squamous cell carcinoma, Merkel cell carcinoma or sweat gland carcinoma who underwent SLNE with ICG-(99m)Tc-nanocolloid (cohort A) or with the standard (99m)Tc-nanocolloid (cohort B). RESULTS: Overall SLNs were identified preoperatively in all 20 patients (100%) in cohort A and in 18 of 20 patients (90%) in cohort B. The SLN basin was detected preoperatively in 18 patients (90%) in cohort A and also in 18 patients (90%) in cohort B. SLNs were identified intraoperatively in all 20 patients (100%) in cohort A and in 19 patients (95%) in cohort B (p = 0.487). Metastatic SLNs were detected in 9 patients (22.5%), 3 (15.0%) in cohort A and 6 (30.0%) in cohort B (p = 0.228). CONCLUSION: The hybrid tracer ICG-(99m)Tc-nanocolloid is an innovative imaging tracer, reliably and readily providing additional information for the detection and excision of SLN in the head and neck region. Therefore, SLNE with combined radioactive and NIR fluorescence guidance is an attractive option for improving the SLN detection rate in patients with cutaneous head and neck malignancies.
Authors: N S Van Den Berg; T Buckle; G I Kleinjan; W M Klop; S Horenblas; H G Van Der Poel; R A Valdés-Olmos; F I Van Leeuwen Journal: Q J Nucl Med Mol Imaging Date: 2014-06 Impact factor: 2.346
Authors: Joost R van der Vorst; Boudewijn E Schaafsma; Floris P R Verbeek; Stijn Keereweer; Jeroen C Jansen; Lilly-Ann van der Velden; Antonius P M Langeveld; Merlijn Hutteman; Clemens W G M Löwik; Cornelis J H van de Velde; John V Frangioni; Alexander L Vahrmeijer Journal: Oral Oncol Date: 2012-08-28 Impact factor: 5.337
Authors: Henk G van der Poel; Tessa Buckle; Oscar R Brouwer; Renato A Valdés Olmos; Fijs W B van Leeuwen Journal: Eur Urol Date: 2011-04-01 Impact factor: 20.096
Authors: K E Wells; D P Rapaport; C W Cruse; W Payne; J Albertini; C Berman; G H Lyman; D S Reintgen Journal: Plast Reconstr Surg Date: 1997-09 Impact factor: 4.730
Authors: Sergi Vidal-Sicart; Fijs W B van Leeuwen; Nynke S van den Berg; Renato A Valdés Olmos Journal: Eur J Nucl Med Mol Imaging Date: 2015-07-22 Impact factor: 9.236
Authors: Ingo Stoffels; Philipp Jansen; Maximilian Petri; Lukas Goerdt; Titus J Brinker; Klaus G Griewank; Thorsten D Poeppel; Dirk Schadendorf; Joachim Klode Journal: JAMA Netw Open Date: 2019-08-02