8. Results

4. Preoperative identification of the sentinel lymph node

no suspicious lymph nodes were found by ultrasound.

sentinel lymph node, which was marked on the skin.

repeated the static recordings again in 30 min.

5. Scintigraphy

88 Cancer Survivorship

Preoperatively we determined the neck status of all the patients with the ultrasound. The study included the patients with T1 and T2 cancers of the oral cavity and oropharynx in whom

Approximately, an hour before the surgical procedure, a lymphoscintigraphy of the tumor region was performed. The static and dynamic scintigraphy allowed for the localization of the

For the determination of the sentinel lymph node, we used the Tc-nanocolloid. We used Nanocoll, produced by Amersham Health (Italy). Nanocoll is a set for the preparation of 99 m Tc-albumin nanocolloid. At least 95% of the parts of this colloid are equal or smaller than 80 nm. We used 2–4 mCi, which correlates to 7,4–14,8 mBq. The amount of the radiocolloid used depended on the size of the tumor. Radiocolloid was injected at four different areas in close proximity to the tumor (above, below, left, and right; or clockwise—12, 3, 6, and 9 o'clock). By changing the needle positioning, we are able to infiltrate by colloid the entire tumor region. After the injection of the radiocolloid, the patient rinsed their mouth with water to remove any possible radiocolloid residues which might have influenced the investigation. 10 minutes after the application of the radiocolloid, we started to follow its movement along the lymphatics into the closest lymph nodes. For the detection of the radiocolloid, we used a gamma-ray

After an hour, we also made static recordings in the anteroposterior and lateral projections. Static scintigraphy allowed for the marking of the sentinel lymph node location on the overlying skin of the neck. If we were unable to identify the sentinel lymph node after an hour, we

In this way, with the use of static and dynamic scintigraphy, we were able to identify the

After we localized the sentinel lymph nodes with scintigraphy, we performed an elective selective dissection. After raising the subplatysmal skin flap, we injected the methylene blue

For the methylene blue dye, we used a Patent Blue V dye (Laboratorie Guerbet, Aulanay-Sous-Bois, France). The amount injected depended on the size of the tumor (from 0.5 to 2 ml) since the entire area of the tumor had to be filled. We observed the spreading of the dye and

camera Picker SX 300. Dynamic scintigraphy lasted between 45 and 60 min.

correct sentinel lymph nodes and limit any possible "skip" metastases [23].

6. Intraoperative identification of the sentinel lymph node

dye to the same area where scintigraphy was performed before.

Forty patients were treated with this method. In 18 out of 40 patients, we found metastases. In 10 of these 18 patients, the metastases were already discovered with the classical method (i.e., first cut of the sentinel lymph node). In 8 of the 18 patients with metastases, the metastases were only discovered after the serial slicing and immunocytochemical staining. In 3 of 10 patients in whom the metastases were already found with the classical method, the metastases were also found in the other lymph nodes, which meant that the N classification in these three patients changed from N0 to N2b. With the use of serial cuts of all sentinel lymph nodes, the classification changed from N0 to N2b in 4 of 7 patients.
