Beyond sentinel node biopsy: preliminary results of indocyanine green-guided neck dissection in cN0 tongue cancer
Year: 2026
Type: article
Abstract: Objective: Neck management in oral cancer is crucial, as regional involvement strongly affects survival. Elective dissection leaves out 10% of recurrences, mainly at levels IV-V or contralateral. Sentinel node biopsy is a different strategy to detect unexpected lymphatic drainage. Our aim is to develop a tumour-specific lymphatic mapping approach for locally-advanced cN0 tongue cancers by combining scintigraphy biopsy with indocyanine green (ICG) guidance. Methods: In this multicentre prospective pilot study lymphatic drainage was evaluated preoperatively using scintigraphy and intraoperatively with ICG fluorescence. Bilateral neck dissection was first performed removing ICG enhancing nodes, then those identified by gamma probe and lastly the remaining ones. Results: Nine patients were enrolled. Robbin's levels mostly enhanced were IB-IIA-III (83%), followed by level IV (66%), IIB (50%) and IA (33%). The ICG method showed a sensitivity of 100%, a positive predictive value of 47% compared to lymphoscintigraphy and of 6.3% compared to metastatic nodes. A negative predictive value of 100% was observed by both. Conclusions: A tailored lymphography-guided neck dissection could provide an effective lymphatic mapping with any individual variation allowing to overcome the limitations of sentinel biopsy and pitfalls associated with traditional elective treatment.
Language: English
Topic: Head and Neck Cancer Studies
Subfield: Otorhinolaryngology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $323
OpenAlex ID: W7135070043