Role of indocyanine green combined with radiotracer-Technetium 99 m in neck surgery for primary and recurrent head and neck cancer: preliminary results of a tertiary cancer center

Suslu N. S., KATAR O., TUNCEL M.

EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY, vol.279, no.3, pp.1549-1560, 2022 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 279 Issue: 3
  • Publication Date: 2022
  • Doi Number: 10.1007/s00405-021-06931-1
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, BIOSIS, CAB Abstracts, EMBASE, MEDLINE, Veterinary Science Database
  • Page Numbers: pp.1549-1560
  • Keywords: Indocyanine green, Tc-99m, Head and neck cancer, Sentinel, Radioguided occult lesion localization, LYMPH-NODE BIOPSY, SQUAMOUS-CELL CARCINOMA, PROGNOSTIC-FACTORS, ORAL-CANCER, DISSECTION, METASTASES, MANAGEMENT, PAPILLARY, PATTERNS
  • Hacettepe University Affiliated: Yes


Purpose Neck dissection (ND), whether therapeutic or elective, is an essential component of the treatment of head and neck squamous cell carcinoma (HNSCC). Due to altered anatomy and fibrosis caused by initial treatments, surgeons face challenges during salvage ND. A combination of Technetium-99 m and indocyanine green (ICG) previously used in the sentinel lymph node (SLN) biopsy for oral cavity cancers, may be useful in different types of neck surgeries. We aimed to show the additional advantage of this combination in detecting HNSCC and thyroid cancer recurrences, as well as individual lymphatic drainage in elective ND. Methods We retrospectively reviewed medical records of patients, underwent neck surgery guided with ICG and Tc-99 m, in Hacettepe University Hospital between June 2018 and December 2020. In a total of 28 patients, intraoperative gamma probes were paired with near infrared (NIR) cameras. Patients are divided into two groups: neck surgery with recurrent occult lesion localization (NS- ROLL) (n: 14) and ND with SLN screening (ND-SLNS) (n: 14). Results Among all 14 patients in NS-ROLL group, recurrent diseases, hidden behind tissues were 100% successfully localized. In ND-SLNS group, 238 lymph nodes were harvested, metastasis rate was 31.3% (10/32) in sentinel nodes. SLNS revealed 100% accuracy in detecting metastasis in clinically N0 neck (10/238). Contralateral lymphatic drainage was observed in three patients (lateral-sided oral cavity SCC). In two patients (floor of mouth), three sentinel nodes were detected by NIR only. Conclusion The use of ICG-radiotracer provides additional value in disease removal for both primary and recurrent tumors of the head and neck.