Lymphoscintigraphy for Sentinel Node Mapping in Head and Neck Cancer.

The aim of this comprehensive review is to describe and analyze the role of the sentinel node mapping in head and neck cancers. For this purpose, head and neck neoplasms have been categorized in cutaneous malignancies and neoplasms of the upper aerodigestive tract. A concise description of lymphatic drainage will be the "prelude" for each section, as well as the description of the injection techniques, when specific. Concisely, the attention has been focused on detection rate of the sentinel node by lymphoscintigraphy for each cancer, and for those patients in which the sentinel lymph node has been identified, true-positives rates, false-negative rates, and overall accuracy has been pointed out. Overall, in cutaneous neoplasms of the head and neck, the detection rate is higher than 90%, however the false-negative rate is still an issue, in particular in melanoma, inducing the need for newer developments. In fact, new tracers and techniques are already available, while prospective multicenter trials exploring the outcome impact are needed in the near future. For the upper aerodigestive tract and in particular oral cavity and oropharynx, sentinel lymph node identification by lymphoscintigraphy allows avoiding unnecessary neck dissection and/or node irradiation. Even in this case, the main limit remains the risk of false-negative rates. While, for patients affected by laryngeal and hypopharyngeal cancers the data seem very limited and, although the feasibility has been demonstrated, performances of this lymphoscintigraphy still need to be confirmed by multicenter studies.

Sentinel Node Mapping in Gynecologic Cancers: A Comprehensive Review.

Gynecologic cancers are one of the most important causes of women death worldwide. The sentinel lymph node concept was introduced by Cabanas in 1977 for the penile cancer. This technique was proven safe and feasible in selected cancers such as breast cancer, melanoma, or some gynecologic cancers. Sentinel lymph node mapping is increasingly used in early stages of cervical or vulvar cancer in particular due to the safety, high detection rate, and sensitivity of the technique. In this review, we will discuss in depth the most recent evidence of nuclear medicine and other techniques used to determine the status of the sentinel lymph node in women affected by gynecologic neoplasms. Although significant efforts have been already done in order to address several issues, there are still determined questions without a clear answer, in particular for endometrial, ovarian, and vaginal neoplasms.