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Summary Rationale Inadequate intraoperative visualization of the sentinel node can hamper its harvest. Freehand SPECT is a 3D tomographic imaging modality based on the concepts of SPECT, which can be used for intraoperative visualization and navigation towards the sentinel node in order to improve its localization and removal during surgery. Patients and methods The use of freehand SPECT was evaluated during 66 sentinel node biopsy procedures in early stage oral cancer patients. Intraoperative detection of sentinel nodes was compared with preoperative identified sentinel nodes on lymphoscinitigraphic examination. Additional value of freehand SPECT was subjectively scored by the surgeon directly following the biopsy procedure. Results Freehand SPECT was able to detect 94% of sentinel nodes intraoperatively. Most sentinel nodes not detected (7 out of 9) were located in level I of the neck. Freehand SPECT appeared to be of additional value for facilitating the intraoperative detection of the sentinel node in 24% of procedures. Conclusion The use of the freehand SPECT system is feasible in the intraoperative detection of sentinel nodes in early stage oral cancer. Freehand SPECT provides helpful information facilitating the SN biopsy procedure in a quarter of cases. However, freehand SPECT cannot detect all SNs which are located in the vicinity of the injection site. [ABSTRACT FROM AUTHOR]

Introduction: The aim was to analyse prognosticators in acinic cell carcinoma (AciCC) in two head and neck referral centers in Amsterdam, the Netherlands.Materials and Methods: Eighty- nine cases of AciCC treated between 1979 and 2016 were retrospectively reviewed. Five, - 10 -and 20- year estimates of survival were executed as well as univariate analysis of prognosticators.Results: The majority of AciCC were T1-T2; 89%. Two percent had nodal disease (2%). The most affected organ was the parotid gland (84%) with a female preponderance (67%). Mean age was 52 years with most cases diagnosed in the fourth to sixth decade. The majority of patients received adjuvant radiotherapy. Elective neck dissection (END) in the N0 neck showed no metastases. High grade transformation (HGT) was found in 21% of cases. Median follow up was 101.9 months. Median time to recurrence was 26 months. Nine patients developed distant metastases (DM) of whom 6 had HGT-AciCC. Median survival with DM was 7 months. Five,- ten -and twenty- year estimates were 84%, 81% and 81% for recurrence free survival respectively. Negative clinical features were advanced stage disease and tumour size > 2.6 cm. Negative histological features were a high mitotic rate, HGT, close and involved surgical margins and necrosis.Conclusion: AciCC- HGT excluded- of the head and neck has an excellent prognosis and shows acceptable long term results. END can be considered as part of the standard treatment due to the relative high incidence of HGT- AciCC and low accuracy of cytology. [ABSTRACT FROM AUTHOR]

Summary: Background: Adenoid cystic carcinoma is a rare salivary gland malignancy with a poor disease free survival due to frequent distant metastases and late local recurrences. Previous single-center reports on outcome mostly encompass small series. In this report a relative large series of 105 cases is analyzed, all treated at the VU University Medical Center, Amsterdam, The Netherlands over a 30-year period in which treatment strategies remained unchanged. Methods: All cases of ACC of the head and neck between 1979 and 2009 at our institution were analyzed through a medical chart review. Recurrence patterns and possible prognostic factors (T-stage, N-status, age, gender, type of salivary gland involved, histological grade, surgical margins, perineural invasion (PNI) and postoperative radiotherapy (RT)) were analyzed. Results: One-hundred and five cases of ACC of the head and neck were identified. Five-, ten- and twenty-year survival rates for overall survival were 68%, 52% and 28%, respectively. T-stage, N-status, surgical margins, histological subtype and age were highly significant predictors for survival. PNI was not a negative prognosticator. Conclusions: T-stage, N-status, surgical margins, histological grade and age are the main predictors of survival-outcome in ACC of the head and neck. Distant metastasis frequently develop, mainly in the first 5years post treatment. Local recurrences often develop even later on, warranting long term follow up of patients treated for ACC. Grade III ACC should be considered a specific entity within the group of ACC due to its typical aggressive biological behavior and relatively poor outcome, implicating the need for an improved adjuvant treatment. [Copyright &y& Elsevier]

Rationale: This study evaluates the lymphatic drainage patterns and determines the accuracy of the sentinel lymph node biopsy (SLNB) in patients diagnosed with a cT1-2N0 OSCC and a history of neck surgery or radiotherapy in three Dutch head and neck centers.Materials and Methods: Retrospective analysis of 53 cT1-2N0 OSCC patients, who underwent SLNB between 2007 and 2016, after a history of neck surgery or radiotherapy. Ten patients had previous treatment of the neck only contralateral from the current tumour. These ten patients were not used for the analysis of lymphatic drainage patterns. The 43 patients with previous ipsilateral or bilateral treatment of the neck had a history of ipsilateral SLN extirpation (n = 9; 21%), neck dissection (n = 16; 37%), radiotherapy (n = 10; 23%), or combined neck dissection and radiotherapy (n = 8; 19%).Results: SLNs were detected in 45 patients, resulting in an identification rate of 85% (45/53). Three patients (7%) had at least one positive SLN. One patient (1/45; 2%) was diagnosed with regional recurrence during the follow-up after a negative SLNB (sensitivity 75%, negative predictive value 98%). The first SLN was detected in level I-III in 58% of the patients, unexpected drainage patterns were observed in 30% (first SLN level IV 9% and level V 5% and contralateral neck in well-lateralized tumours 16%). In 12% no lymphatic drainage pattern was visible.Conclusions: SLNB seems to be a reliable procedure for neck staging of cT1-2N0 OSCC patients with a previously treated neck. SLNB determines the individual lymphatic drainage patterns, enabling visualization of unexpected drainage pattern variability in 30% of these patients. [ABSTRACT FROM AUTHOR]

Background: To analyse outcome with regard to histological features in patients treated for adenoid cystic carcinoma (ACC) in the VU University Medical Center, Amsterdam, The Netherlands. Material–methods: All cases of ACC of the head and neck treated between 1979 and 2009 were analysed through a medical chart review and histopathological revision. Recurrence patterns and possible histological prognostic factors such as histological subtype according to Perzin and Szanto’s grading system (grade I: predominantly tubular, no solid component, grade II: predominantly cribriform, less than 30% solid and grade III: solid component >30%), surgical margins (positive, close and clear) and perineural invasion (PNI) were analysed. Uni- and multivariate statistical tests were performed with SPSS version 15.0® (IBM, New York, USA). Results: One-hundred and five cases of ACC of the head and neck were identified. The most affected major salivary gland was the parotid gland. With regard to the minor salivary glands, the oral cavity and oropharynx were the predominant sites for ACC. Five-, ten- and twenty-year survival rates for disease specific survival (DSS) were 73%, 53% and 45%, respectively. For overall survival (OS) values were 68%, 49% and 25%, respectively. 89% of cases showed positive or close surgical margins, where the group of clear surgical margins mainly consisted of T1–2 major salivary gland tumors. Surgical margins were a significant factor for DSS (p =0.004) as well as for OS (p <0.000). Hazard Ratios (HR) for OS in patients with positive and close surgical margins were 8.1 and 2.3, respectively. With regard to histological subtype, 26% of cases were grade I, 47% grade II and 27% grade III. DSS (p <0.000) and OS (p <0.000) were highly significant. On multivariate analysis, HR for OS was 2.7 for grade II and 3.8 for grade III respectively. PNI was seen in 70% of cases and was a negative prognosticator in terms of DSS and OS on univariate analysis (p =0.033 and 0.042 respectively) and showed a HR of 4.9 on multivariate analysis. Conclusions: Adequate surgical margins, although difficult to achieve, are an important prognosticator. A predominantly tubular histology has the best prognosis, followed by cribriform and solid subtype. The latter can best be considered a high grade malignancy. PNI is a negative prognosticator regardless of named nerve involvement. There is a need for improved adjuvant treatment after surgery in ACC of the head and neck. [Copyright &y& Elsevier]

Summary: Objectives: With the current diagnostic techniques a considerable percentage of occult lymph node metastases are missed in the clinically negative (cN0) neck. Therefore, in patients with laryngeal cancer and cN0 neck a total laryngectomy is usually combined with elective neck dissection. Based on the risk of occult lymph node metastases the decision whether to perform a neck dissection or not is difficult. In recurrent laryngeal cancer or second primary tumors previous treatment possibly influences lymphatics and metastatic behavior. In this pilot study we investigated the feasibility of sentinel node (SN) identification and potential accuracy of sentinel node biopsy (SNB) in laryngeal cancer patients undergoing total laryngectomy with elective neck dissection. Patients and methods: Patients with cN0 laryngeal cancer were included. During surgery 40MBq 99mTechnetium labeled Nanocolloid was endoscopically injected around the tumor. Lymphoscintigraphy was not performed. We identified the sentinel node (SN) ex vivo in the neck dissection specimen with a gammaprobe. Histopathological examination of the neck dissection specimen served as reference test. Results: We included 19 patients, 13 patients with untreated necks and six with prior neck treatment. SN identification was successful in 68.4% (13/19) of patients, and significantly higher in patients with untreated necks (92.3% versus 16.7%, p <0.01). Four of 13 (30.7%) patients would potentially be upstaged by SNB. Sensitivity and negative predictive value would have been 80.0% and 87.5%, respectively. Conclusion: With the current methodology, SN identification in laryngeal cancer patients undergoing total laryngectomy is feasible in patients with untreated necks. Further studies are needed to determine the exact accuracy of SNB in total laryngectomy patients. [Copyright &y& Elsevier]