Anders Christensen1, Karina Juhl2, Katalin Kiss3, Giedrius Lelkaitis4, Birgitte Wittenborg Charabi5, Jann Mortensen6, Andreas Kjær7, Christian von Buchwald8. 1. Department of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen East, Denmark; Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen East, Denmark. Electronic address: anders.christensen.03@regionh.dk. 2. Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen East, Denmark. Electronic address: karina.juhl@sund.ku.dk. 3. Department of Pathology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen East, Denmark. Electronic address: katalin.kiss@regionh.dk. 4. Department of Pathology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen East, Denmark. Electronic address: giedrius.lelkaitis@regionh.dk. 5. Department of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen East, Denmark. Electronic address: birgitte.wittenborg.charabi@regionh.dk. 6. Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen East, Denmark. Electronic address: jann.mortensen@regionh.dk. 7. Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen East, Denmark. Electronic address: andreas.kjaer@regionh.dk. 8. Department of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen East, Denmark. Electronic address: christian.von.buchwald@regionh.dk.
Abstract
INTRODUCTION: Lymph node yield (LNY) in neck dissection has been identified as a prognostic factor in oral cavity cancer. The purpose of this study was to investigate the impact of additional use of optical imaging on LNY in therapeutic ND in oral cancer. METHODS:Consecutive patients with oral squamous cell carcinoma with clinical neck metastasis planned for primary tumor resection were randomized to conventional neck dissection or near-infrared fluorescence (NIRF)-guided neck dissection, respectively. In the intervention group, patients were injected with ICG-Nanocoll prior to surgery. Intraoperatively, an optical hand-held camera system was used for lymph node identification. Also, NIRF imaging of the neck specimen was performed, and optical signals were pinned with needle markings to guide the pathological examination. The endpoint of the study was LNY per neck side in levels Ib-III. RESULTS:31 patients were included with 18 neck sides in the control group and 18 neck sides in the intervention group for evaluation. During NIRF-guided ND, individual lymph nodes could be identified by a bright fluorescent signal and individual tumor-related drainage patterns could be observed in the neck. The LNY in the intervention group was significantly higher compared to the control group (p = 0.032) with a mean of 24 LN (range: 12-33 LN in levels Ib-III compared to 18 LN (range: 10-36 LN) in the control group, respectively. CONCLUSIONS:NIRF-guided ND significantly improved the nodal yield compared to the control group. Intraoperative real-time optical imaging enabled direct visualization of tumor-related drainage patterns within the neck lymphatics.
RCT Entities:
INTRODUCTION: Lymph node yield (LNY) in neck dissection has been identified as a prognostic factor in oral cavity cancer. The purpose of this study was to investigate the impact of additional use of optical imaging on LNY in therapeutic ND in oral cancer. METHODS: Consecutive patients with oral squamous cell carcinoma with clinical neck metastasis planned for primary tumor resection were randomized to conventional neck dissection or near-infrared fluorescence (NIRF)-guided neck dissection, respectively. In the intervention group, patients were injected with ICG-Nanocoll prior to surgery. Intraoperatively, an optical hand-held camera system was used for lymph node identification. Also, NIRF imaging of the neck specimen was performed, and optical signals were pinned with needle markings to guide the pathological examination. The endpoint of the study was LNY per neck side in levels Ib-III. RESULTS: 31 patients were included with 18 neck sides in the control group and 18 neck sides in the intervention group for evaluation. During NIRF-guided ND, individual lymph nodes could be identified by a bright fluorescent signal and individual tumor-related drainage patterns could be observed in the neck. The LNY in the intervention group was significantly higher compared to the control group (p = 0.032) with a mean of 24 LN (range: 12-33 LN in levels Ib-III compared to 18 LN (range: 10-36 LN) in the control group, respectively. CONCLUSIONS: NIRF-guided ND significantly improved the nodal yield compared to the control group. Intraoperative real-time optical imaging enabled direct visualization of tumor-related drainage patterns within the neck lymphatics.
Authors: Tessa Buckle; Maarten van Alphen; Matthias N van Oosterom; Florian van Beurden; Nina Heimburger; Jaqueline E van der Wal; Michiel van den Brekel; Fijs W B van Leeuwen; Baris Karakullukcu Journal: Cancers (Basel) Date: 2021-05-28 Impact factor: 6.639