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Berger DMS, van den Berg NS, van der Noort V, van der Hiel B, Valdés Olmos RA, Buckle TA, KleinJan GH, Brouwer OR, Vermeeren L, Karakullukçu B, van den Brekel MWM, van de Wiel BA, Nieweg OE, Balm AJM, van Leeuwen FWB, Klop WMC. Technologic (R)Evolution Leads to Detection of More Sentinel Nodes in Patients with Melanoma in the Head and Neck Region. J Nucl Med 2021; 62:1357-1362. [PMID: 33637591 PMCID: PMC8724899 DOI: 10.2967/jnumed.120.246819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/28/2021] [Indexed: 11/16/2022] Open
Abstract
Sentinel lymph node (SN) biopsy (SNB) has proven to be a valuable tool for staging melanoma patients. Since its introduction in the early 1990s, this procedure has undergone several technologic refinements, including the introduction of SPECT/CT, as well as radioguidance and fluorescence guidance. The purpose of the current study was to evaluate the effect of this technologic evolution on SNB in the head and neck region. The primary endpoint was the false-negative (FN) rate. Secondary endpoints were number of harvested SNs, overall operation time, operation time per harvested SN, and postoperative complications. Methods: A retrospective database was queried for cutaneous head and neck melanoma patients who underwent SNB at The Netherlands Cancer Institute between 1993 and 2016. The implementation of new detection techniques was divided into 4 groups: 1993-2005, with preoperative lymphoscintigraphy and intraoperative use of both a γ-ray detection probe and patent blue (n = 30); 2006-2007, with addition of preoperative road maps based on SPECT/CT (n = 15); 2008-2009, with intraoperative use of a portable γ-camera (n = 40); and 2010-2016, with addition of near-infrared fluorescence guidance (n = 192). Results: In total, 277 patients were included. At least 1 SN was identified in all patients. A tumor-positive SN was found in 59 patients (21.3%): 10 in group 1 (33.3%), 3 in group 2 (20.0%), 6 in group 3 (15.0%), and 40 in group 4 (20.8%). Regional recurrences in patients with tumor-negative SNs resulted in an overall FN rate of 11.9% (group 1, 16.7%; group 2, 0%; group 3, 14.3%; group 4, 11.1%). The number of harvested nodes increased with advancing technologies (P = 0.003), whereas Breslow thickness and operation time per harvested SN decreased (P = 0.003 and P = 0.017, respectively). There was no significant difference in percentage of tumor-positive SNs, overall operation time, and complication rate between the different groups. Conclusion: The use of advanced detection technologies led to a higher number of identified SNs without an increase in overall operation time, possibly indicating an improved surgical efficiency. Operation time per harvested SN decreased; the average FN rate remained 11.9% and was unchanged over 23 y. There was no significant change in postoperative complication rate.
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Affiliation(s)
- Danique M S Berger
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands;
| | - Nynke S van den Berg
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Vincent van der Noort
- Department of Biometrics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Bernies van der Hiel
- Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Renato A Valdés Olmos
- Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Tessa A Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gijs H KleinJan
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - Oscar R Brouwer
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Lenka Vermeeren
- Department of Otorhinolaryngology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Baris Karakullukçu
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Bart A van de Wiel
- Department of Pathology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands; and
| | - Omgo E Nieweg
- Melanoma Institute Australia and Central Medical School, University of Sydney, Sydney, Australia
| | - Alfons J M Balm
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - W Martin C Klop
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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KleinJan GH, Karakullukçu B, Klop WMC, Engelen T, van den Berg NS, van Leeuwen FWB. Introducing navigation during melanoma-related sentinel lymph node procedures in the head-and-neck region. EJNMMI Res 2017; 7:65. [PMID: 28819936 PMCID: PMC5560283 DOI: 10.1186/s13550-017-0312-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 07/25/2017] [Indexed: 11/10/2022] Open
Abstract
Background Intraoperative sentinel node (SN) identification in patients with head-and-neck malignancies can be challenging due to unexpected drainage patterns and anatomical complexity. Here, intraoperative navigation-based guidance technologies may provide outcome. In this study, gamma camera-based freehandSPECT was evaluated in combination with the hybrid tracer ICG-99mTc-nanocolloid. Materials and methods Eight patients with melanoma located in the head-and-neck area were included. Indocyanine green (ICG)-99mTc-nanocolloid was injected preoperatively, whereafter lymphoscintigraphy and SPECT/CT imaging were performed in order to define the location of the SN(s). FreehandSPECT scans were generated in the operation room using a portable gamma camera. For lesion localization during surgery, freehandSPECT scans were projected in an augmented reality video-view that was used to spatially position a gamma-ray detection probe. Intraoperative fluorescence imaging was used to confirm the accuracy of the navigation-based approach and identify the exact location of the SNs. Results Preoperatively, 15 SNs were identified, of which 14 were identified using freehandSPECT. Navigation towards these nodes using the freehandSPECT approach was successful in 13 nodes. Fluorescence imaging provided optical confirmation of the navigation accuracy in all patients. In addition, fluorescence imaging allowed for the identification of (clustered) SNs that could not be identified based on navigation alone. Conclusions The use of gamma camera-based freehandSPECT aids intraoperative lesion identification and, with that, supports the transition from pre- to intraoperative imaging via augmented reality display and directional guidance.
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Affiliation(s)
- Gijs H KleinJan
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Hospital, Albinusdreef 2, C2-S zone, 9600, 2300 RC, Leiden, the Netherlands.,Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - Baris Karakullukçu
- Department of Head and Neck Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - W Martin C Klop
- Department of Head and Neck Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - Thijs Engelen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Hospital, Albinusdreef 2, C2-S zone, 9600, 2300 RC, Leiden, the Netherlands
| | - Nynke S van den Berg
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Hospital, Albinusdreef 2, C2-S zone, 9600, 2300 RC, Leiden, the Netherlands.,Department of Head and Neck Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Hospital, Albinusdreef 2, C2-S zone, 9600, 2300 RC, Leiden, the Netherlands. .,Department of Head and Neck Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
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Kuvat SV, Karakullukçu B, Hafiz G, Arinci A, Pilanci O, Aköz E. Head and neck reconstruction with dorsoradial forearm free flap: a preliminary clinical study. B-ENT 2009; 5:259-263. [PMID: 20163053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
UNLABELLED Head and neck reconstruction with dorsoradial forearm free flap: a preliminary clinical study. PROBLEMS/OBJECTIVES The most common criticism of the radial forearm free flap (RFFF) is donor site morbidity. Delayed or defected integration of split thickness skin graft (STSG) is the most commonly encountered complication. Defective healing or excessively thin skin coverage of important forearm structures, such as the median nerve and ulnar artery-nerve bundle, places these structures at increased risk of injury. The current study aims to modify the RFFF to utilize a dorsoradial skin island in order to protect the volar tissue aspect of these structures. METHODOLOGY Seven patients were included in the study between 2005 and 2008. All patients had oncologic resections in the oral cavity necessitating free tissue transfer. The main variation from the standard RFFF technique is that the medial incision was placed 1 cm lateral to the palmaris longus tendon. The dissection was extended laterally and dorsally, depending on the necessary flap size. The donor side defect was covered with a thigh STSG. RESULTS None of the patients had partial or complete flap necrosis. This surgical modification provided tissue coverage along the course of the median nerve and ulnar neurovascular bundle. CONCLUSIONS Dorsoradial forearm free flap is a feasible technique that allows preservation of tissue coverage on the volar surface of the forearm.
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Affiliation(s)
- S V Kuvat
- Istanbul University, Istanbul Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery.
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Abstract
Acute tonsillitis is a common childhood disease, but repeated antibiotic treatment may fail, leading to tonsillectomy. Superficial swab cultures do not sufficiently represent the core bacteria present, but fine-needle aspiration may be a promising diagnostic method. We evaluated 58 patients undergoing tonsillectomy, and took superficial and core swabs, and fine-needle aspirations. Staphylococcus aureus was the most common bacterial pathogen identified, present in 26 out of 50 (52%) positive core cultures, followed by Haemophilus influenza in 13 positive core cultures (26%), and group A beta-haemolytic streptococci in 10 positive core cultures (20%). Fine-needle aspiration detected 33 out of 50 positive core cultures (66%), whereas superficial swab culture detected 18 of 50 (36%); the difference being statistically significant. All pathogens detected by superficial swabs and fine-needle aspiration were detected in core cultures. The sensitivity and specificity of fine-needle aspiration were 66% and 100%, respectively, compared with 36% and 100% for superficial swabs. Fine-needle aspiration is therefore a promising method for detecting core bacteria in patients with recurrent tonsillitis.
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Affiliation(s)
- E Inci
- Department of Otolaryngology, Head and Neck Surgery, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey.
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Abstract
Lipoid proteinosis is a rare disease that presents with hyaline deposits in many tissues. It involves predominantly the skin and upper aerodigestive tract, presenting with small yellowish papules and hoarseness. It may involve the central nervous system and cause intracerebral calcifications. Laryngeal lesions may resemble singer's nodule or chronic laryngitis. The pathogenesis of the disease is not clear although several studies suggest a defective collagen production and/or lysosomal storage disease. In this article two cases with skin and larynx involvement are reported.
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Affiliation(s)
- Ferhan Oz
- Department of Otolaryngology, Head and Neck Surgery, Istanbul University Cerrahpasa Medical Faculty, Turkey
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Abstract
Primary mucosal malignant melanomas are rare. They appear late in life and their prognosis is grave. Although there is no consensus on therapy, wide surgical resection followed by radiotherapy, chemotherapy and immunotherapy are treatment modalities. In this report we present a case of widespread primary mucosal malignant melanoma located in the pharynx. After immunotherapy (four cycles of interleukin-2 and interferon-alpha) and chemotherapy (four cycles of cisplatin and dacarbazine) has been applied as primary therapy for suppression of the mass, transoral total pharyngeal resection was performed. After surgery three cycles of immunotherapy and three cycles of chemotherapy were administered followed by radiotherapy (total dose of 6600 cGy). An additional three cycles of immunotherapy and chemotherapy were administered. Although no local recurrence was observed during the 14 months of follow-up after the completion of radiotherapy, cranial and lung metastasis were detected in the 12th month.
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Affiliation(s)
- O Oztürk
- Department of Otolaryngology, Head and Neck Surgery, Istanbul University, Cerrahpaşa Medical Faculty, Turkey.
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