Sentinel lymph node biopsy with preoperative CT lymphography and intraoperative indocyanine green fluorescence imaging for N0 early tongue cancer: A long-term follow-up study.

PURPOSE: This study evaluated the usefulness of sentinel lymph node (SLN) biopsy with preoperative computed tomographic lymphography (CTL) and intraoperative indocyanine green (ICG) fluorescence imaging for N0 early tongue cancer. METHODS: Twenty-seven patients with N0 early oral tongue cancer underwent CTL with a 128-slice multi-detector row CT scanner to detect SLN on the day before resection of primary tumor and SLN biopsy under ICG fluorescence guidance. We identified the location and number of SLNs mapped by CTL and evaluated whether CTL-enhanced SLNs could be identified intraoperatively as ICG fluorescent lymph nodes. Prognosis was also evaluated. RESULTS: SLNs were detected by CTL in 26 of 27 patients (96.3%). The total and mean numbers of SLNs were 41 and 1.5, respectively. All SLNs enhanced by CTL could be identified intraoperatively as ICG fluorescent lymph nodes. Two SLNs were found under ICG fluorescent guidance in only one patient without SLN enhanced by CTL. Among the 27 patients, five (18.5%) had SLN with metastasis. Median follow-up was 76 months (range 44-82 months). During follow-up, three of 22 patients without SLN metastasis had occult cervical lymph node metastasis. The 5-year overall survival rate was 100%. CONCLUSION: SLN biopsy with preoperative CTL and intraoperative ICG fluorescence imaging is a feasible and reliable procedure, without radioisotope tracers, for neck management in cases of early tongue cancer.