CT Lymphography Using Lipiodol(®) for Sentinel Lymph Node Biopsy in Early-Stage Oral Cancer

This study evaluated sentinel lymph node (SLN) identification with CT lymphography (CTL) following peritumoral administration of Lipiodol(®) relative to conventional (99m)Tc-nanocolloid lymphoscintigraphy (including SPECT/CT) in 10 early-stage oral cancer patients undergoing SLN biopsy. Patients first underwent early dynamic and static scintigraphy after peritumoral administration of (99m)Tc-nanocolloid. Subsequently, Lipiodol(®) was administered at the same injection sites, followed by fluoroscopy and CT acquisition. Finally, late scintigraphy and SPECT/CT were conducted, enabling the fusion of late CTL and SPECT imaging. The next day, designated SLNs were harvested, radiographically examined for Lipiodol(®) uptake and histopathologically assessed. Corresponding images of CT, (99m)Tc-nanocolloid lymphoscintigraphy and SPECT/late CTL fusion were evaluated. (99m)Tc-nanocolloid lymphoscintigraphy identified 21 SLNs, of which 7 were identified with CTL (33%). CTL identified no additional SLNs and failed to identify any SLNs in four patients (40%). Out of six histopathologically positive SLNs, two were identified by CTL (33%). Radiographic examination confirmed Lipiodol(®) uptake in seven harvested SLNs (24%), of which five were depicted by CTL. CTL using Lipiodol(®) reached a sensitivity of 50% and a negative predictive value (NPV) of 75% (median follow-up: 12.3 months). These results suggest that CTL using Lipiodol(®) is not a reliable technique for SLN mapping in early-stage oral cancer.