Three-dimensional imaging and navigated sentinel node biopsy for primary parotid malignancy: new application in parotid cancer management.

BACKGROUND Applications for sentinel node biopsy (SNB) in the head and neck are increasing with new lymphatic tracers and imaging techniques allowing previously inaccessible tumor sites to benefit from the procedure. We show that lymphatic drainage from a primary parotid malignancy can be accurately mapped using navigational surgery. METHODS A patient with radiologically classified N0 intraparotid malignancy underwent peritumoral injection of 99mTc-nanocolloid. Planar imaging and single photon emission CT (SPECT)/CT identified the sentinel node. At surgery, real-time video combined with 3 dimensional (3D) images of intraoperative radioisotope hot spots directed the surgeon to the sentinel node. RESULTS Lymphoscintographic images demonstrated the hot nodes, which were easily retrieved intraoperatively by 3D navigation. Three lymph nodes were removed, all were free of metastasis. CONCLUSION The morbidity associated with total parotidectomy and elective neck dissection in low-risk malignancies may be avoided with SNB. This technique is applicable to other sites within the head and neck.