A multi-institutional feasibility lead-in trial of lymphatic mapping with SPECT-CT for evaluating contralateral disease in lateralized oropharynx cancer using 99m-technetium sulfur colloid.

Kevin Higgins, David Goldstein, Michael Au, Han Zhang, John R de Almeida, Leba Michael Sarkis, Christopher Mkl Yao, Aaron Hendler, Ravi Mohan, Antoine Eskander, Danielle MacNeil, Sharon Tzelnick, Ali Hosni

Journal: Head & neck 2024;46(12):3038-3045

PMID: 39016220

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Abstract

BACKGROUND

Lymphatic mapping with SPECT-CT has been demonstrated to accurately define lymphatic drainage patterns in oropharyngeal cancer but there has yet to be a study demonstrating its feasibility across multiple institutions.

METHODS

Twelve adult patients with lateralized oropharyngeal carcinoma (T1-T3) who were planned for definitive or adjuvant radiotherapy without contralateral nodal disease underwent injection of 99-m technetium sulfur colloid followed by static planar lymphoscintigraphy to verify tracer migration, and SPECT-CT acquired at 30 ± 15 min (optional) and 3 h (±1 h) (mandatory time-point).

RESULTS

All 12 patients completed the study with 7/12 patients having the injections performed under local anesthetic and 5 patients requiring general anesthetic. There were no tracer migration failures and there were no serious adverse events or complications encountered. Four out of 12 patients (33%) showed contralateral drainage patterns.

CONCLUSIONS

Lymphatic mapping with SPECT-CT of lateralized oropharyngeal squamous cell carcinoma can be performed safely across multiple institutions.

Address: Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.; Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.; Department of Joint Medical Diagnostic Imaging, University Health Network, Toronto, Ontario, Canada.; Department of Otolaryngology - Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada.; Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.; Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada.; Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada.

DOI: 10.1002/hed.27871

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MeSH Terms: Adult, Aged, Female, Humans, Male, Middle Aged, Carcinoma, Squamous Cell, Feasibility Studies, Lymphatic Metastasis, Lymphoscintigraphy, Oropharyngeal Neoplasms, Radiopharmaceuticals, Single Photon Emission Computed Tomography Computed Tomography, Technetium Tc 99m Sulfur Colloid