Medical Radiology and Radiation Safety. 2012. Vol. 57. No. 6. P. 58-67


I.S. Romanov, A.A. Odjarova, D.B. Udintsov, Y.V. Vishnevskaya, M.I. Nechushkin, L.P. Yakovleva, V.I. Sokorutov, K.D. Ilkaev

Identification of Sentinel Lymph Nodes in Squamous Cell Carcinoma of the Oral Cavity by Lymphoscintigraphy

N.N. Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.


Purpose: To satisfy that lymphoscintigraphy prior the operation and the intraoperative method gamma-probe using provide to detect the sentinel nodes. Because the pathomorphological status of the sentinel node can evidently reflect presence or absence of the occult metastatic spread in the head and neck lymph groups in patients suffering of squamous cell carcinoma of the oral cavity with clinically (cN0) - negative lymph node occult regional metastases status.

Material and methods: There were 45 patients included in our study with oral cancer, their representative status of the neck lymph nodes was considered as clinically negative (cN0). Before 24 - hours prior the operation, these patients have been undergone the peritumoral injection with radiopharmaceutical agent, known as NANOCIS 99mTc traced and then the lymphoscintigraphy of the neck lymph nodes has being performed. During the operation the precise localization of the sentinel node was additionally explored by the gamma-probe Neo 2000 R, and followed by the sentinel node alone removing. The next stage was the primary tumor incision and functional neck dissection on levels I-V was performed due to standards. The removed species were studied by the pathologist in routine way.

Results: It was possible to reveal the sentinel nodes presence in all patients of the group. Occult metastatic lymph node spread was appeared in 33.3 % patients. The most often level for the metastases location was the subdigastrical (IIA) -in about 60 % The most remote localization of the metastatic spread was the lower jugular group lymph nodes (level IV) - 6.7 %. False-negative results were mentioned in 4.4 % cases. It means that there were no any metastases in sentinel nodes but there was detected the presence of metastatic spread at some point in some others parts of the neck tissue. The accuracy was 95 %, the sensitivity was 87 % and the negative predictive value was - 94 %, respectively.

Conclusions: The method of the lymphoscintigraphy prior the operation and the intraoperative method of the gamma-probe using give an opportunity to detect the sentinel nodes evidently in a case of squamous cell carcinoma of the oral cavity. The patomorphological status of the sentinel nodes, which being removed during the operation, can objectively assess the metastatic spread to the regional lymph nodes

Key words: sentinel lymph nodes, oral cancer, lymphoscintigraphy