DUGi

Can a presurgical lymphogammagraphy aid in early detection of occult contralateral neck metastasis in contralateral cN0 T3- staged squamous cell tongue cancer non-midline invasive?

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BACKROUND. Squamous cell tongue cancer (SCTC) has a poor survival rate, especially when lymph nodes are involved. Detecting these nodes is challenging, and current imaging methods have limitations. Official guidelines lack clarity on treating advanced cases with clinically contralateral negative necks. We propose adding pre-surgical SPECT/CT Lymphogammagraphy and Sentinel Lymph Node Biopsy (SLNB) to the standard approach. These techniques have shown high accuracy, minimal risk, and precise anatomical imaging in other tumors and SCTC early stages, potentially improving the early detection and treatment of occult contralateral lymph node metastasis in clinically negative contralateral necks of T3 non-midline invasive SCTC. OBJECTIVES. The primary aim of this study is to assess the sensitivity of pre-surgical SPECT/CT Lymphogammagraphy in identifying potential contralateral lymphatic drainage from the primary lingual tumor. In cases where contralateral lymph nodes are detected using this technique, participants will undergo a SLNB. Depending on the results, patients may become eligible for additional contralateral neck dissection. All participants will be monitored for a period of 2 years to track the progression of the cancer and to identify any instances of contralateral neck relapse, particularly in cases where the initial sentinel node study yielded negative results, affecting specificity and predictive values. Secondary objectives of the study involve evaluating the rate of contralateral neck metastasis within our sample and exploring the impact of initial N-stage and tumor size on the outcomes. DESIGN AND METHODOLOGY. This study was designed as a longitudinal prospective 2-center study, oriented mainly for the principal objective. Secondary objectives will be assessed by a transversal design to confirm initial results (proxy data). PARTICIPANTS. 118 patients diagnosed with T3-staged non-midline invasive squamous cell tongue cancer that show no contralateral neck metastasis in standard imaging techniques (CT/MRI). All patients must be eligible and in agreement for the corresponding surgical intervention

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