Sensitivity and specificity of sentinel lymph node biopsy in patients with oral squamous cell carcinomas using indocyanine green fluorescence imaging

Ahmed Al-Dam; Clarissa Precht; Armelle Barbe; Carsten Kohlmeier; Henning Hanken; Johannes Wikner; Gerhard Schön; Max Heiland; Alexandre T Assaf

doi:10.1016/j.jcms.2018.05.039

Sensitivity and specificity of sentinel lymph node biopsy in patients with oral squamous cell carcinomas using indocyanine green fluorescence imaging

J Craniomaxillofac Surg. 2018 Aug;46(8):1379-1384. doi: 10.1016/j.jcms.2018.05.039. Epub 2018 May 23.

Authors

Ahmed Al-Dam¹, Clarissa Precht², Armelle Barbe³, Carsten Kohlmeier², Henning Hanken², Johannes Wikner², Gerhard Schön⁴, Max Heiland⁵, Alexandre T Assaf⁶

Affiliations

¹ Department of Oral and Maxillofacial Surgery, Sheikh Khalifa General Hospital Umm Al Quwain, (Head: Ahmed Al-Dam, MD, DMD), Al Salama, Opp. Ministry of Social Affairs, Umm Al Quwain, United Arab Emirates.
² Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, (Head: Henning Hanken, MD, DMD, PhD), Martinistr. 52, 20246, Hamburg, Germany.
³ Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, (Head: Stefan W. Schneider, MD, DMD), Martinistr. 52, 20246, Hamburg, Germany.
⁴ Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, (Head: Heiko Becher, PhD), Martinistr. 52, 20246, Hamburg, Germany.
⁵ Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Free University of Berlin, Humboldt-University of Berlin, and Berlin Institute of Health, (Head: Max Heiland, MD, DMD, PhD), Augustenburger Platz 1, 13353, Berlin, Germany.
⁶ Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, (Head: Henning Hanken, MD, DMD, PhD), Martinistr. 52, 20246, Hamburg, Germany. Electronic address: a.assaf@uke.de.

PMID: 29907432
DOI: 10.1016/j.jcms.2018.05.039

Abstract

Purpose: The purpose of this clinical study was to evaluate the sensitivity and specificity of cervical sentinel lymph node biopsy after mapping with indocyanine green fluorescence (ICG) for imaging early-stage oral cancer.

Patients and methods: A sentinel lymph node biopsy (SLNB) was performed during a selective neck dissection (SND) in 20 patients with oral squamous cell carcinoma (OSCC, cT1 or cT2, N0 status). The sentinel lymph nodes (SLN) were identified using an infrared video camera after ICG injection. Lymph nodes were examined histologically. The endpoint of this study was to investigate the rate of false-negative results in SLNB.

Results: Sentinel lymph nodes could be detected after 8.1 min (range 1-22 min). In eight out of 20 cases, lymph node metastases were found during histopathological evaluation of the neck dissection specimen. In four cases a metastasis could be found in the detected SLN (sensitivity 50%). In the other four cases metastases were found in different lymph nodes. Specificity was 100%, positive predictive value 100%, and negative predictive value 75%.

Conclusion: In this study, reliability of sentinel lymph node biopsy after ICG imaging could not be verified, as there were false-negative results in 50% of the cases. Therefore, SND can still be recommended as for patients with cT1 or cT2 OSCC, and a N0 neck status.

Keywords: Head and neck cancer; ICG; Lymph node metastases; Oral cancer; Sentinel lymph node biopsy.

MeSH terms

Adult
Aged
Aged, 80 and over
Carcinoma, Squamous Cell / diagnosis
Carcinoma, Squamous Cell / pathology*
Female
Fluorescence
Fluorescent Dyes / therapeutic use*
Humans
Indocyanine Green / therapeutic use*
Male
Middle Aged
Mouth Neoplasms / diagnosis
Mouth Neoplasms / pathology*
Neck Dissection
Sensitivity and Specificity
Sentinel Lymph Node Biopsy / methods*

Substances

Fluorescent Dyes
Indocyanine Green