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Clinical Cases

Sentinel Lymph Node Biopsy in Head & Neck

Which information could support finding all lymph nodes with minimal morbidity?

The sentinel lymph node concept in head and neck malignancies is not yet standard in everyday clinical routine. This is due to surgical difficulties arising from the proximity of the radioactive lymph nodes to the tumor (injection site of the radioisotope). With the provided equipment of only a radiation detector for sentinel lymph node identification it is in most cases impossible to differentiate the sentinel lymph node(s) from the injection site. The declipse®SPECT imaging introduces for the first time instrumentation that the first lymph node in the drainage of the tumor can be visualized and thus precisely targeted during surgical treatment [Heuveling2012]. Furthermore, the functionality to co-register preoperative SPECT/CT and PET/CT datasets in the declipse®SPECT solution makes it a powerful image guidance solution for head and neck malignancies.

3-D HEAD AND NECK SENTINEL LYMPH NODE IMAGING ROOM BEFORE INTERVENTION:

  • Full 3-D image acquisition ensures precise identification and localization
  • Direct correlation with anatomy enables orientation and referencing
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Figure: The image shows a 3-D imaging of a sentinel lymph node in the neck of a melanoma patient. The intra-operative imaging has the possibility of precise planning with intra-operative 3-D imaging and visualization for a minimally invasive incision and direct removal of the sentinel lymph node(s). The picture shows the real-time video image overlay for intuitive guidance.

NAVIGATION TO THE SENTINEL NODES DURING INTERVENTION:

  • Orientation, localization and identification in 3-D ensure safety during procedure
  • Depth measurement enables direct and minimally invasive access
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Figure: The depth measurement in the head & neck region provides valuable information for minimally invasive removal of the sentinel lymph node through a direct access path without large trauma of surrounding tissue.

CONTROL OF COMPLETE RESECTION OF ALL SENTINEL NODES

  • 3-D scan provides confirmation of complete removal of radioactive sentinel nodes
  • Documentation enables transparent and reliable follow up treatments
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Figure: A 3-D image in the operation room directly after the removal of the sentinel lymph node documents the complete removal in the head & neck area. This also spares further damage of the surrounding tissue due to manual search for remaining radioactivity.
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