Lymphatic mapping with SPECT-CT for evaluation of contralateral drainage in lateralized oropharyngeal cancers using an awake injection technique

Carissa M Thomas; Mohemmed N Khan; Ravi Mohan; Aaron Hendler; Ali Hosni; Douglas B Chepeha; David P Goldstein; Richard M Cooper; John R de Almeida

doi:10.1002/hed.26011

Lymphatic mapping with SPECT-CT for evaluation of contralateral drainage in lateralized oropharyngeal cancers using an awake injection technique

Head Neck. 2020 Mar;42(3):385-393. doi: 10.1002/hed.26011. Epub 2019 Nov 28.

Authors

Carissa M Thomas^{1

2}, Mohemmed N Khan^{1

2}, Ravi Mohan³, Aaron Hendler³, Ali Hosni⁴, Douglas B Chepeha^{1

2}, David P Goldstein^{1

2}, Richard M Cooper³, John R de Almeida^{1

2}

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
² Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
³ Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.

PMID: 31778005
DOI: 10.1002/hed.26011

Abstract

Background: Risk of contralateral nodal metastases in oropharyngeal squamous cell carcinoma (OPSCC) is currently based on clinical risk factors. We propose lymphatic mapping with single photon emission computed tomography (SPECT-CT) for tumor-specific delineation of lymphatic drainage to guide treatment.

Methods: Retrospective review of lymphatic drainage patterns in cT1-2 OPSCC and contralateral cN0 neck with a nonoperative, awake injection of 99 m-Tc sulfur colloid and SPECT-CT.

Results: Ten patients were reviewed. Primary sites included tonsil (n = 8, 80%) and tongue base (n = 2, 20%). All patients tolerated awake injections with no complications. Nine patients (90%) demonstrated satisfactory migration of radiotracer to neck node(s) with seven (78%) to the ipsilateral lateral neck, one (11%) to the ipsilateral lateral neck and retropharynx, and one (11%) to bilateral lateral neck nodes.

Conclusions: Characterization of lymphatic drainage in OPSCC is feasible using a nonoperative injection technique and SPECT-CT. Drainage to the contralateral neck is rare, warranting further study to tailor treatment appropriately.

Keywords: SPECT-CT; awake injection; lymphoscintigraphy; neck dissection; oropharyngeal squamous cell carcinoma; sentinel lymph node biopsy; transoral robotic surgery.

MeSH terms

Carcinoma, Squamous Cell* / surgery
Carcinoma, Squamous Cell* / therapy
Head and Neck Neoplasms*
Humans
Lymph Nodes / diagnostic imaging
Oropharyngeal Neoplasms* / diagnostic imaging
Oropharyngeal Neoplasms* / therapy
Retrospective Studies
Sentinel Lymph Node Biopsy
Tomography, Emission-Computed, Single-Photon
Tomography, X-Ray Computed
Wakefulness