A multidisciplinary team trial in a tertiary care centre in patients with early stage squamous cell carcinoma of oral cavity to review the established role of advanced imaging modalities like lymphoscintigraphy and SPECT-CT in sentinel lymph node identification and to layout our experience in performing this modality.
A randomised, prospective, case control study of diagnosed cases of T1/T2 N0 squamous cell carcinoma of oral cavity undertaken from December 2016 to January 2018 at our institution of which the patients in study group underwent SLNB guided neck dissection and the patients in control group underwent Elective Neck Dissection. We compared both the groups in terms of the operating time , the post-operative histopathology , the diagnostic accuracy and the outcomes which were statistically analysed. Also we studied and analysed the efficacy of static and dynamic lymphoscintigraphy followed by SPECT-CT in identifying sentinel lymph node areas in neck and intra-operative gamma probe use to precisely locate the sentinel nodes.
Out of 40 patients,20 each in study and control groups were included. The SLN identification rate was 100% with combined SPECT-CT and gamma probe use whereas it was 70% with imaging alone. The sensitivity, specificity, positive predictive value and negative predictive value of SLNB and END were 80% , 56.58%, 9.61%, 98% and 78.5 %, 73.48% ,10.67% , 98.8 % respectively. The operating time was less in the SLNB group with statistically significant difference between the two groups.
High SLN identification rate with combined use of SPECT-CT and gamma probe and high NPV render SLNB as a reliable modality in the management of early stage oral cavity cancers in a centre with a multidisciplinary team set up and appropriate facilities.