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Technetium-99m-marked sentinel lymph node biopsy for oral squamous cell carcinoma as a safe and effective procedure
Christian Soemmer1,2, Felix Bärenfänger1, Evangelos Vitkos1,2
1Health Faculty, University of Witten/Herdecke, Witten, Germany.
Introduction:
Sentinel lymph node biopsy (SLNB) using [99mTc]Tc-albumin nanocolloid has emerged as a minimally invasive staging technique for selected patients with oral squamous cell carcinoma (OSCC). This study evaluates the feasibility of SLNB, the quality of patient selection, and radiation exposure during the procedure.
Materials And Methods:
This retrospective single-center study included patients with oral squamous cell carcinoma clinically staged as cT1-cT2 cN0 who underwent SLNB using [99mTc]Tc-albumin nanocolloid. Sentinel lymph nodes were identified by preoperative imaging and intraoperative gamma probe detection. Histopathological findings guided further treatment. Radiation exposure to the surgeon was estimated using a point-source approximation. Clinical, pathological, and follow-up data were analyzed descriptively.
Results:
A total of 16 patients were included (11 males, 5 females; mean age 70.9 ± 11.1 years). Occult lymph node metastases were detected in 3 of 16 patients (18.8%), while tumor upstaging (pT>cT) occurred in 1 patient (6.3%). Sentinel lymph nodes were successfully identified in all patients. The mean administered technetium-99m activity was 100.9 ± 2.1 MBq, and surgery was performed after a mean interval of 26 h 03 min. The mean duration of surgery was 111.5 min. During surgery, the remaining radioactive activity averaged 5.1 MBq, and the surgeon's mean radiation exposure was 2.3 μSv. During follow-up, no regional nodal recurrences or delayed nodal failures were observed, and all patients were alive at the time of database lock.
Conclusion:
Sentinel lymph node biopsy may represent a feasible staging approach in carefully selected patients with early-stage oral squamous cell carcinoma and clinically negative lymph nodes (cN0). The procedure demonstrated a high identification rate, low estimated radiation exposure, and successful detection of occult nodal metastases. However, the limited sample size and follow-up duration warrant cautious interpretation of the oncologic outcomes, and further prospective studies are required before the role of SLNB relative to elective neck dissection can be established.
