lymphoscintigraphy in head and neck skin cancers: an atlas

e-mail: nmcrh@hotmail.com

4th International Sentinel Node CongressDecember 3 - 6, 2004

Santa Monica, CA USA

Introduction: The lymphatic system of the

head and neck consists of complex networks

of collecting vessels and about 300 nodes

(1/5 of the total body nodes). The valves in

these vessels are more numerous than those

in the lower limbs. This anatomical

characteristic together with the effect of

gravity favours a more rapid lymph flow in

the head and neck. A dynamic or early static

lympho scintigraphy is a reliable method of

identifying the Sentinel Nodes (SN) in head

and neck skin cancers.

Methods: Between Nov. ’99 and April 2004

55 patients (34m, 21f) with head and neck

skin cancers were enrolled on our study. 37

melanoma cT2-3N0, 14 with Lip Squamous

Cell Carcinoma (SCC) cT2N0 and 4 patients

with Merkel disease. 30-50 MBq of 99mTc-

Albumin-Nanocoll, diluted in 0.3 mL was

injected intradermally, into two perilesional

points. A planar static scintigraphy was

acquired immediately after the injection

visualising the lymph drainage pathways. A

SN radioguided biopsy was performed three

hours after lymphscintigraphy.

Results: SNs were observed on the I-II

Neck Level (NL) within 5 minutes of the

injection in 20 patient; 14 cases of cheek

tumour, 4 nose cancers and 2 tumours on

the eyelids. In 14/15 patients with SCC on

the lip the SNs were detected on Ia-Ib NL.

In 5 up to 7 patients with ear localisation

SNs were detected in the pre-auricular

region and in 2 patients on NL II. In the 7

patients with parieto temporal localisation

the SNs in 3 cases were detected in the

retroauricolar region, in 2 cases in the

occipital region and in 2 cases on the IV-V

NL. In 1 patient with melanoma of frontal

region, 2 SNs were detected in the bilateral

retroauricolar region, and 1 SN on NL IV.

In 5 patients with a neck tumour the lymph

drainage was observed in all directions,

including the cranial direction. Pathologic

upstaging of the clinically N0 neck occurred

in 7 (13%) of 55 patients.

Conclusion: The unpredictability of

lymphatic drainage in head and neck skin

cancers depends strongly on the tumour site.

By using nanocolloids were observed that

the radioactivity of the first sentinel node

decreases quickly and therefore we

recommend a short interval between

scintigraphy and a radioguided biopsy no

more than 3 hours.

Lymphoscintigraphy in Head and Neck Skin Cancers: An Atlas of Sentinel Node Mapping

Girolamo Tartaglione, M.D. *, Clemente Potenza, M.D. **, Alessio Caggiati, M.D. **, Marino Maggiore. M.D. **, Marco Pagan, M.D.

* Department of Nuclear Medicine, Cristo Re Hospital, Rome, Italy ** Department of Plastic Surgery, IDI IRCCS, Rome, Italy

SN 2004 Poster No. 134

5 min 10 min

Melanoma T2a - Right Cheek

2 SNs- on Ib NLR

Melanoma T1b - Right Cheek

2 SNs- on Ia NLR

Merkel Disease - Right Cheek

2 SNs+ on Ib NLR

Melanoma T2 - Right Cheek

1 SN- on Ib NLR

Melanoma T2a - Right Cheek

1 SN- on Ib NLR , 1SN- on II NLR

Melanoma T2a - Right Cheek

1 SN- on II NLR, 1 SN- Parotid RMelanoma T2 - Right Cheek

2 SNs- on I NLR

Melanoma T - Left Cheek

1 SN- V NLL

Melanoma T1b - Right Cheek

1 SN- on Ib NLR

Melanoma T3 - Right Cheek

2 SN+ on I NLR

Melanoma T1b - Left Cheek

2 SNs- on I NLL

Melanoma T4a - Right Cheek

1 SN+ on I NLR, 1 SN on IV NLR

Melanoma T3a - Right Cheek

2 SN- on I NLR, 1 SN- on IV NLR

Melanoma T2a - Right Cheek

1 SN- on Ib NLR

Melanoma T4a - Left Nose

2 SN- on I NLL

Merkel Disease - Left Sup Eyelid

1 SN- on Ib NLL

Melanoma T3 - Occipital

1 SN+ Occipital

Melanoma T3 - Right Inf Eyelid

1 SN+ on II NLR

Melanoma T4a - Right Nose

1 SN- on I NLR

Melanoma - Right Nose

1 SN- on Ib NLR

Melanoma - Right Nose

1 SN- on I NLR, 1 SN- II NLR

SCC T2N – Lower Lip

3 SNs- on I NLL

SCC T2 - Right Lip Commissure

1 SN- on I NLR

SCC T2 - Right Lower Lip

1 SN- on I NLR , 1 SN- II NLR

SCC T2- Right Lower Lip

2 SN- on I NLR, 1 SN- on II NLR

(same pt) SCC T2 - Right Lower Lip

2 SN- on I NLR, 1 SN- on II NLR

SCC T2 - Left Lower Lip

1 SN- on I NLL

(same pt) SCC T2 - Left Lower Lip

1 SN- on I NLL (ant view)

SCC T2 - Left Lower Lip cT2

1 SN- on I NLL

SCC T2 - Right Lower Lip

2 SNs- on I NLRSCC T2 – Right Upper Lip

1 SN- on I NLR

SCC T2 - Right Lip Commissure

1 SN- I NLR, 1 SN II NLR

SCC T2 - Left Lower Lip

1 SN- I NLL, 1 SN- II NLL

SCC T2 - Right Lip Commissure

2 SNs- on I NLR

SCC cT2N0 - Upper Left Lip

1 SN- Ia NLL

Merkel Disease of Upper Lip

1 SN+ on I NLL

(same pt) Merkel Disease of Upper Lip

1 SN+ on I NLL (ant view)

SCC T2 - Left Lip Commissure

2 SNs- I NLL, 1 SN- V NLL

SCC T2 - Upper Lip

1 SN- Ia NL

(same pt) SCC T2 - Upper Left Lip

1 SN- on I NLL (Lat view)

Melanoma T2a of Right Ear

1SN- II NLR , 1 SN- on IV NLR

Melanoma T3a of Left Ear

1 SN- Ib NLL, 1 SN- IV NLL

Melanoma T1b - Parietal

1 SN- V NLL (2 SN- retroauricolar R & L)

SCC T2- Left Lower Lip

1 SN- on I NLL

Melanoma - Right Ear

1 SN- II NLR

Melanoma T2a - Right Ear

1SN- on Retroauricolar R

Melanoma T1a - Right Ear

1SN- on Ib NLR

Melanoma T3a Left Ear

1SN- on Ib NLL , 1 SN- on IV NLL

Melanoma T2a - Left Ear

1SN+ on II NLL, 1 SN on IV NLL

(same pt.) Melanoma T1b - Parietal

2 SNs- on Retroauricolar L (& R) ,1 SN- V NLR

Melanoma T1a - Right Parietal

1 SN- on Retroauricolar R, 1 SN- IV NLR Melanoma T2a - Left Parietal

1 SN- on II NL Left

Melanoma T2a - Left Occipital

1 SN- on Occipital L

Melanoma T3a Parietal R

2 SNs- on I NLR, (1 SN- on IV NLL)

Merkel Disease - Left Parietal

2 SN- on Ib NLL, 1 SN- on Left Parotid

Melanoma T1b - Frontal

1 SN- on Occipital, 1 SN- on II NLR,

1SN- on II NLL

(same pt) Melanoma T1b – Right Frontal

1 SN- on Occipital, 1SN- on II NLR,

1SN- on II NLL

Melanoma T3a - Left Neck

3 SNs- on I, IV, V NLL

Melanoma T2a - Left Neck

4 SN- on IV,V NLL

Melanoma T1a - Left Neck

1 SN- on V NLL

Melanoma T2a - Right Neck

1 SN- on I NLR

Melanoma T3a - Right Neck

1 SN on II NLR, 1 SN on IV NLR

(same pt) Melanoma T3a - Right Neck

1 SN on II NLR, 1 SN on IV NLR

R