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neck tumours – Comparison of ultrasound and CT
106 Journal of Cranio-Maxillofacial Surgery 34(2006) Suppl. S1 dissection. SUVmax values of the primary and benign and metastatic lymph nodes were measured and compared with each other and histopathology. Results: The SUVmax value of the primary and all neck lymph nodes with uptake decreased after intra-arterial chemotherapy significantly from a median of 6.2 to 3.7 (p = 0.04) and 3.5 to 2.4 (p = 0.004), respectively. Twelve/17 patients had cervical metastases showing significant decrease of the SUVmax value from 3.6 to 2.7 (p = 0.03). Benign lymph nodes did not reveal a significant SUVmax decrease (p = 0.13). Conclusions: Local chemotherapy seems to have an influence on cervical lymph nodes. It cannot be stated yet whether this result demonstrates decreasing inflammatory reaction in the lymph nodes or an anti-neoplastic effect of cisplatin via the lymphatics but a regional effect of intraarterial cisplatin is proved. O.389 Cervical lymph nodes in patients with malignant head/neck tumours – Comparison of ultrasound and CT B. Hohlweg-Majert1 , P. Voss1 , M.C. Metzger1 , D. Schulze2 . 1 Department of Craniomaxillofacial Surgery, University Hospital, Freiburg, Germany; 2 Department of Head and Neck Diagnosing, University Hospital, Freiburg, Germany Introduction and Objectives: Malignant lymph node spread due to malignancies of the head and neck can be observed regularly. In the cervical region sentinel lymph nodes like in axillar or supraclavicular region are not described. Therefore, a precise lymph node screening of all neck compartments is required. Material and Methods: Twenty-five patients with a primary malignant tumour in the head and neck area underwent a lymph node staging of the head by means of both CT and ultrasound. Based on the level system of Som et al (AJR 2000, 174, 837–844) the lymph nodes were classified. Within ultrasound the longest transversal and longitudinal diameter were measured while within CT only the two longest transversal diameters were recorded. The study was performed by two independent observers. Results: Most of the transformed lymph nodes were found in level IIa and III. With ultrasound a more precise measurement was observed. The right positive rate of sonographically detected malignant lymph nodes was significantly higher compared to CT reading. Conclusion: Cervical lymph node staging can be performed safely by ultrasound. It is a cheap, easy-to-handle and cost effective diagnostic method. However, with a linear transducer only the uppermost regions of the neck were accessible. Despite of that ultrasound is reliable and valuable tool of lymph node screening in case of head and neck malignancy. O.390 Efficacy of lymphoscintigraphic sentinel node detection for cervical staging of patient with squamous cell carcinoma T. Meresse, C. Dekeister, F. Jalbert, P. Payoux, J.R. Paoli. Hopital Purpan, Oral and Maxillofacial Department, Toulouse, France Introduction and Objectives: Squamous cell carcinoma of oral cavity frequenly involves nodes, even in N0 necks. In such situation, selective neck dissection is frequenly performed for staging purpose. The study was designed to evaluate the feasibility and staging ability of the sentinel node (SN) technique for patients with squamous cell carcinoma of the oral cavity or oropharynx and clinically and radiologically negative necks. Patients and Method: Prospective study compares the histopathologic status of SN with that of the remaining neck dissection tissues. Thirty previously untreated patients with T1
Abstracts, EACFMS XVIII Congress to T4 squamous cell carcinoma of oral cavity or oropharynx and clinically and radiologically negative necks (N0) were included in the study. Unfiltered technetium Tc 99 m sulphur colloid injections of the primary tumour and lymphoscintigraphy were performed on the day before surgery. Intraoperatively, the SN was localized with a gamma probe and removed after tumour resection and during neck dissection. Results: Nodes were identified in 29 patients/37 neck. In 30 necks, there were no positive nodes. In 5 patients, the SN were the only histopathologically positive nodes. In 1 patient, SN and other nodes in the remaining neck tissue were positives. There was 1 false negative case. Conclusion: This prospective study shows that SN may be useful for the staging of N0 necks. The SN technique has the potential to decrease the need of neck dissections for clinically negative necks, thus reducing the associated morbidity for patients and cost.
O.391 Long-term results in supraomohyoid neck dissection S. Dalambiras, N. Lazaridis. Department of Oral and Maxillofacial Surgery, G. Papanikolaou University Hospital of Thessaloniki, Greece The supraomohyoid neck dissection is a selective cervical node dissection. The lymph node groups removed by this procedure belong to levels I, II, III. The sternocleidomastoid muscle, the spinal accesory nerve and the internal jugular vein are preserved. A total of 65 SOHNDs were performed in 57 patients, in the years 1994–2002. The follow-up of those patients was based principally, in the distinction between N(0) and N(+) neck sides on pathologic examination of the specimen. The survival rate of the two groups of patients is presented and data concerning all the related factors of the disease are discussed.
O.392 Comparison of lymphoscintigraphy and dye method of identification of sentinel nodes in oral squamous cell carcinoma ˇ M. Ili´c, R. Zeravica, A. Kiralj. 1 Clinic for maxillofacial Surgery, Clinical Center Novi Sad, 2 Department for Nuclear Medicine, Serbia The presence of occult metastases at T+No oral squamous cell carcinoma is high. That is reason for treatment No neck by elective dissection. Radiolabel and dyed methods are used for identification sentinel lymph nodes (SLN). Static gamma probe lymphoscintigraphy and the handheld gamma probe are used to identify radioactive sentinel nodes. The objective of this study was to evaluate the values of coloured and lymphoscintigraphy techniques for identification sentinel lymph node in patients with oral squamous cell carcinoma. Material and Method: The study included 11 patients with T1−3 N0 oral squamous cell carcinoma. Patients underwent lymphoscintigraphy up to 1 day prior to surgery and by intraoperative injection of Patent blue dye. After sentinel node biopsy followed neck dissection. We compared lymphoscintifraphy and coloured SLN findings. We did not use handheld gamma probe. Results: In all 11 patients was identified coloured sentinel lymph nodes. In 8 patients we identified SLN by lymphoscintigraphy. The most frequent number of SLN discovered in 30 and 120 minutes using static gamma scintigraphy. Higher numbers of SLB were identified by Patent blue coloured method than radiolabel technique.
Abstracts, EACFMS XVIII Congress to T4 squamous cell carcinoma of oral cavity or oropharynx and clinically and radiologically negative necks (N0) were included in the study. Unfiltered technetium Tc 99 m sulphur colloid injections of the primary tumour and lymphoscintigraphy were performed on the day before surgery. Intraoperatively, the SN was localized with a gamma probe and removed after tumour resection and during neck dissection. Results: Nodes were identified in 29 patients/37 neck. In 30 necks, there were no positive nodes. In 5 patients, the SN were the only histopathologically positive nodes. In 1 patient, SN and other nodes in the remaining neck tissue were positives. There was 1 false negative case. Conclusion: This prospective study shows that SN may be useful for the staging of N0 necks. The SN technique has the potential to decrease the need of neck dissections for clinically negative necks, thus reducing the associated morbidity for patients and cost.
O.391 Long-term results in supraomohyoid neck dissection S. Dalambiras, N. Lazaridis. Department of Oral and Maxillofacial Surgery, G. Papanikolaou University Hospital of Thessaloniki, Greece The supraomohyoid neck dissection is a selective cervical node dissection. The lymph node groups removed by this procedure belong to levels I, II, III. The sternocleidomastoid muscle, the spinal accesory nerve and the internal jugular vein are preserved. A total of 65 SOHNDs were performed in 57 patients, in the years 1994–2002. The follow-up of those patients was based principally, in the distinction between N(0) and N(+) neck sides on pathologic examination of the specimen. The survival rate of the two groups of patients is presented and data concerning all the related factors of the disease are discussed.
O.392 Comparison of lymphoscintigraphy and dye method of identification of sentinel nodes in oral squamous cell carcinoma ˇ M. Ili´c, R. Zeravica, A. Kiralj. 1 Clinic for maxillofacial Surgery, Clinical Center Novi Sad, 2 Department for Nuclear Medicine, Serbia The presence of occult metastases at T+No oral squamous cell carcinoma is high. That is reason for treatment No neck by elective dissection. Radiolabel and dyed methods are used for identification sentinel lymph nodes (SLN). Static gamma probe lymphoscintigraphy and the handheld gamma probe are used to identify radioactive sentinel nodes. The objective of this study was to evaluate the values of coloured and lymphoscintigraphy techniques for identification sentinel lymph node in patients with oral squamous cell carcinoma. Material and Method: The study included 11 patients with T1−3 N0 oral squamous cell carcinoma. Patients underwent lymphoscintigraphy up to 1 day prior to surgery and by intraoperative injection of Patent blue dye. After sentinel node biopsy followed neck dissection. We compared lymphoscintifraphy and coloured SLN findings. We did not use handheld gamma probe. Results: In all 11 patients was identified coloured sentinel lymph nodes. In 8 patients we identified SLN by lymphoscintigraphy. The most frequent number of SLN discovered in 30 and 120 minutes using static gamma scintigraphy. Higher numbers of SLB were identified by Patent blue coloured method than radiolabel technique.