Sentinel Lymph Nodes In Patients Research Articles

Imaging diagnostic methods for identification of sentinel lymph nodes in patients with early squamous cell carcinoma of the oral cavity mucosa: a literature review

The paper describes properties of clinical visualization approaches which are applied for detection of sentinel lymph nodes in patients suffering from oral cavity squamous cell cancer. Diagnostic efficiency results and technological features of different imaging techniques are discussed.

HISTO-PATHOLOGICAL CORRELATION BETWEEN SENTINEL LYMPH NODE BIOPSY AND AXILLARY LYMPH NODE BIOPSY IN PATIENTS WITH CARCINOMA OF BREAST

Introduction: The present study was aimed at mapping of lymphatic passage of sentinel lymph node in patients of carcinoma of breast and to correlate pathology of Sentinel lymph node biopsy (SLNB) and Axillary Lymph node Dissection (ALND). Material and methods: Patients presenting with palpable breast carcinoma without clinically palpable or suspicious axillary lymph nodes, potentially curable breast carcinoma (T1, T2 tumours) who were undergoing ALND and willing to participate in the study were included in the study. Patients with prior axillary operations, large & locally advanced invasive breast cancers, ductal carcinoma in situ, prior breast surgery, prior chemotherapy, distant metastases and pregnant women were excluded from the study. The histopathology of SLNB and ALND were correlated in the patients and sensitivity and specificity of SLNB was calculated. Results: 50 patients were included in the study. The blue staining sentinel lymph node was identified in 30 of 50 (60%) procedures. Of the 30 patients in whom SLN was identified, 1(3.33%) had histologically negative nodes and 29(96.66%) had histologically positive nodes; of 20 patients who had negative sentinel nodes, 19(95%) had histologically negative evidence of axillary metastasis, while 1(5%) showed histologically positive evidence of axillary metastasis. The sensitivity of sentinel lymph node status with comparison to the gold standard i.e., histopathology report, was 96.6% while the specificity was 95%. The overall positive and negative predictive values were 96.67% and 95%, respectively. Conclusion: Although further studies are requires to confirm the findings of the present study, the SLN accurately reflects the status of axillary lymph nodes in most patients with breast cancer, and for those with early stage disease it is rapidly emerging as an alternative to conventional axillary dissection. Key words : Carcinoma Breast, Histopathology, Mapping, Axillary Lymph node Dissection, Sentinel lymph node biopsy

66PD Comparison of blue dye and radio-tracer markers for identification of axillary sentinel node in patients with early breast cancer

66PD Comparison of blue dye and radio-tracer markers for identification of axillary sentinel node in patients with early breast cancer

66PD Comparison of blue dye and radio-tracer markers for identification of axillary sentinel node in patients with early breast cancer

Background Sentinel lymph node biopsy is a standard procedure in treatment of early breast cancer. However, the technique itself and the use of lymphatic markers remain generally unstandardized. Aim of this study is to compare efficacy of sentinel node biopsy using methylene-blue dye, radioactive colloid and dual marker technique. Methods Prospective study includes patients with early breast cancer treated in a single institution from year 2013 to 2015. Three subgroups were created according to the method of lymphatic marking (A¼blue dye, B¼radioactive technetium, C¼dual markers). Sentinel identification rate and the number of marked sentinel nodes was compared between groups. Concordance between two lymphatic markers was assessed using Cochrane’s Kappa statistical method. Results Study includes total of 204 patients. Sentinel node identification rate (95% CI) was 87.4% (þ/- 6.5%) in group A, 94.1% (þ/-8.7%) in B and 100% (þ/- 2.6%) in group C. Median number of marked nodes was one node. There were more hot nodes in group C than in groups A and B (P¼0.002). In group C, concordance index between blue dye and radioactive tracer was relatively weak (kappa¼0.049, 95% CI 0-0.244). Conclusions: Radioactive tracer can be used as single lymphatic marker, however, for best results dual marking is recommended. Methylene blue dye and radioactive Technecium colloid can be considered as complimentary when used simultenously. The use of blue dye as a single lymphatic marker is not recommended because of unacceptably low sentinel identification rate. Legal entity responsible for the study : N/A Funding: N/A Disclosure All authors have declared no conflicts of interest.

Clinical significance of BRAF V600E mutational status in capsular nevi of sentinel lymph nodes in patients with primary cutaneous melanoma

Capsular nevi (CN) are clusters of benign melanocytes situated in the capsule of lymph nodes and occur in up to 20% of lympadenectomy specimens. The molecular profile of CN in relation to prognostic parameters in patients with primary cutaneous melanoma (PCM) has not been previously investigated. We assessed BRAF V600E mutation by immunohistochemistry (IHC) in the CN of sentinel lymph nodes (SLN) in PCM patients and correlated the findings with demographic characteristics, PCM histopathologic and molecular features, and clinical outcome parameters. Seventy-eight cases of CN involving SLN of PCM patients were evaluated for BRAF V600E mutation by IHC. The results were correlated with patient demographics, PCM histopathologic and molecular features, and outcome measures. Thirty-six (46%) of 78 CN cases expressed BRAF V600E mutation by IHC. Nineteen (53%) of those BRAF-positive CN cases were from patients with at least American Joint Committee on Cancer stage II melanoma, whereas 62% of BRAF-negative CN cases (26/42) were from patients with stage I melanoma (P = .013). Twelve (33%) of the 36 BRAF-positive CN cases had metastatic melanoma involving lymph nodes, compared with 14% (6/42) of BRAF-negative CN cases (P = .061). CN mutation status was not associated with patient demographics, histopathologic or molecular features of the PCM, or survival outcomes. A high percentage of CN identified in the SLN of patients with PCM harbor BRAF V600E mutation. Positive mutation was associated with adverse clinicopathological parameters, specifically increased tumor stage and lymph node metastasis. These findings suggest that BRAF V600E mutation in CN of SLN may be useful as an adverse predictive biomarker in patients with melanoma.

A pilot study of SPECT/CT-based mixed-reality navigation towards the sentinel node in patients with melanoma or Merkel cell carcinoma of a lower extremity.

To explore the feasibility of an intraoperative navigation technology based on preoperatively acquired single photon emission computed tomography combined with computed tomography (SPECT/CT) images during sentinel node (SN) biopsy in patients with melanoma or Merkel cell carcinoma. Patients with a melanoma (n=4) or Merkel cell carcinoma (n=1) of a lower extremity scheduled for wide re-excision of the primary lesion site and SN biopsy were studied. Following a Tc-nanocolloid injection and lymphoscintigraphy, SPECT/CT images were acquired with a reference target (ReTp) fixed on the leg or the iliac spine. Intraoperatively, a sterile ReTp was placed at the same site to enable SPECT/CT-based mixed-reality navigation of a gamma ray detection probe also containing a reference target (ReTgp).The accuracy of the navigation procedure was determined in the coronal plane (x, y-axis) by measuring the discrepancy between standard gamma probe-based SN localization and mixed-reality-based navigation to the SN. To determine the depth accuracy (z-axis), the depth estimation provided by the navigation system was compared to the skin surface-to-node distance measured in the computed tomography component of the SPECT/CT images. In four of five patients, it was possible to navigate towards the preoperatively defined SN. The average navigational error was 8.0 mm in the sagittal direction and 8.5 mm in the coronal direction. Intraoperative sterile ReTp positioning and tissue movement during surgery exerted a distinct influence on the accuracy of navigation. Intraoperative navigation during melanoma or Merkel cell carcinoma surgery is feasible and can provide the surgeon with an interactive 3D roadmap towards the SN or SNs in the groin. However, further technical optimization of the modality is required before this technology can become routine practice.

Identified sentinel lymph node in patient with bladder cancer by using intraoperative injection of indocyanine green during laparoscopic radical cystectomy-single center experience

Identified sentinel lymph node in patient with bladder cancer by using intraoperative injection of indocyanine green during laparoscopic radical cystectomy-single center experience

Towards the intra-operative use of Raman spectroscopy in breast cancer-overcoming the effects of theatre lighting.

The ability to use Raman spectroscopy to assess tissue in the operative theatre setting could be advantageous for both patients and clinicians. In this study, a method of overcoming the deleterious effects of theatre lighting on the Raman spectra is demonstrated. The effectiveness of this technique is highlighted both within the theatre setting and using human lymph node tissue. The portable MiniRam II Raman spectroscopy device that incorporated a 785-nm laser was used in all experiments. This is an important step towards the use of Raman spectroscopy as a means of analysing sentinel lymph nodes in patients who have been newly diagnosed with breast cancer.

Increased Angiogenesis and Lymphangiogenesis in Metastatic Sentinel Lymph Nodes Is Associated With Nonsentinel Lymph Node Involvement and Distant Metastasis in Patients With Melanoma.

Lymph node angio- and lymphangio-genesis have been shown to play an important role in the premetastatic niche of sentinel lymph nodes. In the current study we have investigated the association of angio- and lympangio-genesis related parameters in metastatic sentinel lymph nodes of patients with melanoma with the presence of nonsentinel and distant organ metastasis. Peritumoral and intratumoral relative blood and lymphatic vessel areas (evaluated by Chalkley method), blood and lymphatic microvessel densities, and the rates of blood and lymphatic vessel proliferation were assessed in primary tumors and sentinel lymph node metastasis of 44 patients with melanoma using CD34/Ki-67 and D240/Ki-67 immunohistochemical double staining. Primary melanoma exhibited significantly higher rate of lymphatic proliferation compared with its lymph node metastasis (P < 0.05), while lymph node metastasis showed significantly higher rate of blood vessel proliferation (P < 0.05). Using multivariate logistic regression model, the rate of peritumoral lymphatic proliferation was inversely associated with positive nonsentinel lymph node status (P < 0.05), whereas the rate of intratumoral blood vessel proliferation was associated with distant organ metastasis (P < 0.05). Using multivariate Cox regression analysis, the rate of intratumoral blood vessel proliferation was also inversely associated with overall survival of patients with melanoma (P < 0.05).

Worse outcome for patients with recurrent melanoma after negative sentinel lymph biopsy as compared to sentinel-positive patients

BackgroundThe long-term outcome of patients with melanoma who had recurrence after negative sentinel lymph node (SLN) biopsy has rarely been evaluated systematically. MethodsWe searched our databases for melanoma patients with SLN biopsy from the end of 1999 and the beginning of 2011. Data was analyzed using uni- and multivariate statistics as well as Kaplan–Meier curves. ResultsData of 651 patients with melanoma was available for statistics. We observed 451 (69.3%) patients with negative SLN who had no evidence of disease recurrence during follow-up. Recurrence in SLN negative patients was found in 50 (7.7%) cases. Tumor subtypes such as invasive lentigo maligna melanoma and acral melanoma (odds ratio 15.2, P = 0.015) and tumor thickness > 2 mm (odds ratio 3.1, P = 0.0017) were independent predictors for recurrence in patients with negative SLN. Patients with negative SLN and subsequent recurrence had a significantly (P = 0.036) reduced 5-year melanoma-specific survival (MSS) when compared with positive SLN patients. Recurrence of disease in positive SLN patients was observed after a median of 39 months when compared to patients with negative SLN and recurrence (28 months, P = 0.0079). Negative SLN with recurrence was an independent predictor for worse recurrence free and melanoma-related survival. ConclusionsPatients with negative SLN and recurrence experience earlier disease relapses and poorer MSS when compared to patients with positive SLN status implicating that more stringent follow-up procedures are warranted in patients with higher tumor thickness and invasive lentigo maligna and acral melanoma, despite a negative SLN.

Contrast-enhanced ultrasound biopsy of sentinel lymph nodes in patients with breast cancer undergoing neo-adjuvant chemotherapy

Contrast-enhanced ultrasound biopsy of sentinel lymph nodes in patients with breast cancer undergoing neo-adjuvant chemotherapy

Using lymphoscintigraphy as a prognostic tool in patients with cancer

Using lymphoscintigraphy as a prognostic tool in patients with cancer Sergi Vidal-Sicart,1 Renato A Vald&eacute;s Olmos2 1Nuclear Medicine Department, Hospital Cl&iacute;nic Barcelona, Barcelona, Spain; 2Nuclear Medicine Section and Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, the NetherlandsAbstract: Early detection of metastatic involvement of lymph nodes is one of the greatest difficulties faced by the physicians. In the last few centuries, the lymphatic system has become an important field of interest in oncology. The lymphatic system functions in two opposing ways in cancer: defense against circulating tumor cells, and, on the other hand, a route for metastasis and a site of tumor growth when the defense mechanism fails. The significant impact of lymphatic dissemination on the staging, treatment, and outcome of solid cancers has stimulated investigations aimed at gaining more insight into several aspects of the lymphatic system. Its application in oncology has evolved in the last 50 years fostered by the recognition of the relationship of lymph node metastases to prognosis in several types of malignant tumors. Lymphatic mapping also offers the opportunity for repetitive studies undertaken for evaluation of the patient during follow-up, thereby offering early evidence of recurrence of the disease. More recent and widespread applications of lymphoscintigraphy form the basis for biopsy of the sentinel lymph node in patients with solid cancers. This article reviews the applications of lymphoscintigraphy in the current diverse oncologic clinical indications for the assessment of secondary lymphedema related to oncologic treatments and sentinel lymph node lymphatic mapping.Keywords: lymphatic mapping, lymphedema, sentinel node, cancer

SPECT/CT Improves Detection of Metastatic Sentinel Lymph Nodes in Patients with Head and Neck Melanoma.

A positive sentinel lymph node (SLN) is the most important prognostic factor for predicting survival in cutaneous melanoma. This study aimed to evaluate how the addition of single-photon emission computed tomography (SPECT) and computed tomography (CT) to planar lymphoscintigraphy (PL) alters SLN identification, yield, and localization of metastatic nodes in head and neck melanoma. This retrospective review examined patients undergoing SLN biopsy for cutaneous melanoma of the head and neck between July 2003 and December 2015. Patient demographics and pathologic outcomes were compared for patients undergoing SPECT-CT versus PL. A multivariable logistic regression analysis was used to identify factors associated with the identification of a positive SLN. Among 176 patients undergoing SLN biopsy, 91 underwent PL and 85 underwent SPECT-CT and PL. The patients in the SPECT-CT group were older than the PL patients (p=0.050) but the groups did not differ in gender (p=0.447), Breslow thickness (p=0.744), or total number of SLNs identified (p=0.633). As shown by the multivariate regression analysis, only Breslow thickness [odds ratio (OR) 1.47; 95% confidence interval (CI) 1.17-1.84] and SPECT-CT (OR 3.58; 95% CI 1.24-10.4) were associated with a positive SLN. The use of SPECT-CT for patients with head and neck cutaneous melanoma significantly increases the likelihood of retrieving a positive SLN. Long-term follow-up evaluation is needed for further definition of the impact that SPECT-CT has on recurrence and survival.

Sentinel lymph nodes biopsy in early breast cancer and melanoma patients using “Tehnefit 99mTc” radioactive colloid technetium 99mTc

The possibilities and technique of using the radioactive colloid technetium99mTc “Tehnefit 99mTc” to identify and 35 biopsy of sentinel lymph nodes with their morphological examination during operations in patients with early breast cancer and melanoma were studied. The optimal dosage of the active volume and the features the injection of the radioactive colloid for sentinel lymph nodes biopsy using “Technetium99mTc” in patients with breast cancer and melanoma with the best results in the Trial № 1 was determined. The most reliable results of histological and cytological intraoperative examination of sentinel lymph nodes in the diagnosis of metastases was the best in using a combination of both methods. The results of Trials in using radioactive colloid technetium99mTc “Tehnefit 99mTc” to identify and biopsy with morphological examination of sentinel lymph nodes in patients with early breast cancer and melanoma did not display the same results that been compared to the special characteristics of their foreign counterparts, reflecting the impossibility of its use in the diagnosis of metastases in the lymph nodes.

99mTc-Nanocolloid SPECT/MRI Fusion for the Selective Assessment of Nonenlarged Sentinel Lymph Nodes in Patients with Early-Stage Cervical Cancer.

We aimed to explore the accuracy of (99m)Tc SPECT/MRI fusion for the selective assessment of nonenlarged sentinel lymph nodes (SLNs) for diagnosing metastases in early-stage cervical cancer patients. We consecutively included stage IA1-IIB1 cervical cancer patients who presented to our tertiary referral center between March 2011 and February 2015. Patients with enlarged lymph nodes (short axis ≥ 10 mm) on MRI were excluded. Patients underwent an SLN procedure with preoperative (99m)Tc-nanocolloid SPECT/CT-based SLN mapping. When fused datasets of the SPECT and MR images were created, SLNs could be identified on the MR image with accurate correlation to the histologic result of each individual SLN. An experienced radiologist, masked to histology, retrospectively reviewed all fused SPECT/MR images and scored morphologic SLN parameters on a standardized case report form. Logistic regression and receiver-operating curves were used to model the parameters against the SLN status. In 75 cases, 136 SLNs were eligible for analysis, of which 13 (9.6%) contained metastases (8 cases). Three parameters-short-axis diameter, long-axis diameter, and absence of sharp demarcation-significantly predicted metastatic invasion of nonenlarged SLNs, with quality-adjusted odds ratios of 1.42 (95% confidence interval [CI], 1.01-1.99), 1.28 (95% CI, 1.03-1.57), and 7.55 (95% CI, 1.09-52.28), respectively. The area under the curve of the receiver-operating curves combining these parameters was 0.749 (95% CI, 0.569-0.930). Heterogeneous gadolinium enhancement, cortical thickness, round shape, or SLN size, compared with the nearest non-SLN, showed no association with metastases (P= 0.055-0.795). In cervical cancer patients without enlarged lymph nodes, selective evaluation of only the SLNs-for size and absence of sharp demarcation-can be used to noninvasively assess the presence of metastases.

99P Predicting no metastases to axillary lymph nodes beyond positive sentinel nodes in patients with breast cancer: a simple rule

99P Predicting no metastases to axillary lymph nodes beyond positive sentinel nodes in patients with breast cancer: a simple rule

Sebocyte-Like Cell Primary Cutaneous Melanoma

Although rising incidence rates of cutaneous melanoma have been observed during the last 4 decades in white populations worldwide, the sebocyte-like cell variant has been described only twice in the literature to date. In our case, a 64-year-old man presented for evaluation of a changing pigmented lesion on the left upper back. Excision of the lesion revealed an invasive melanoma with a Breslow depth of 3.3 mm. Microscopic sections showed a predominantly dermal-based tumor composed of sheets and nests of enlarged epithelioid melanocytes, most of which showed an uncommon phenotype with multivacuolated cytoplasms and scalloped nuclei, features that gave them a strong resemblance to mature sebocytes. The lesional cells expressed S100 protein, Melan-A, and p16, whereas adipophilin was positive only within the sebocyte-like component of the neoplasm and showed focal nonspecific staining. The patient's sentinel lymph node biopsy was positive for micrometastases, although a subsequent position emission tomography scan was unremarkable. Sebocyte-like melanocytes are a rare distinctive type of melanocytes that can be found mostly in benign but also in malignant melanocytic lesions. They usually present focally within the lesions and, therefore, do not represent a diagnostic problem in nevus or primary cutaneous melanoma. However, when sebocyte-like melanocytes are the main cellular component of a melanocytic lesion or when they are found in the context of metastatic melanoma, they may create a potential diagnostic pitfall; for this reason, awareness of this cell type is important.

Abstract A70: Melanoma-derived nanovesicles as drivers of immunosuppression

Abstract Background: The metastatic advancement of melanoma is largely dependent on its ability to evade immunity and gain access to the lymphatics. Characterization of tumor-draining, sentinel lymph nodes in patients has identified the nodes to express an immunosuppressed, Th2-dominant immune profile. Importantly, this profile is observed in sentinel lymph nodes even prior to evidence of metastasis supporting a model in which melanoma-derived factors prime tumor-draining, sentinel lymph nodes for tumor progression. Recent work in our lab has characterized the cellular interactions and the contribution of soluble factors in facilitating this immunosuppressive immune profile in fresh sentinel lymph nodes of patients; however, an appreciation for the role of subcellular counterparts remains to be explored. In this study, we considered a novel role for melanoma-derived, membrane-bound nanoparticles as drivers in polarizing immunity towards an immunosuppressive, tumor-promoting state. Methods and Results: Utilizing recent technology advances in Nanoparticle Tracking Analysis (NTA), characterization of melanoma derived vesicles from human melanoma cell lines showed a size distribution of particles ranging from 30nm to 1um, representing both exosomes and microvesicles. Following hypoxic culture, vesicle production was amplified, suggesting the increasingly hypoxic tumor microenvironment may trigger vesicle secretion. To evaluate the immune regulating potential of melanoma-derived vesicles, proteomic analysis of vesicle cargo by mass spectrometry identified over 100 proteins including known immune regulators Galectin 3, MHC I, ICAM1 and MIF. Functional assessment revealed that dendritic cells matured in vitro in the presence of melanoma-derived vesicles have significantly reduced surface marker expression of co-stimulatory markers CD80 and CD86 compared to controls. In addition to an activation defect, microarray analysis of dendritic cells matured in the presence of melanoma vesicles displayed a unique RNA expression profile. Pathway analysis of the expression arrays identified numerous overlapping signaling pathways involving proteins present in the melanoma-derived vesicles by mass spectrometry suggesting tumor-derived vesicle cargo has the ability to modulate dendritic cell function. Conclusion: Taken together, this study demonstrates a critical function for melanoma-derived vesicles in driving immunosuppression by characterizing their generation, protein cargo and immune regulating properties. The enrichment of melanoma-derived vesicles for immune mediators and ability of the vesicles to suppress dendritic cell function suggests a mechanism by which regional immunosuppression precedes nodal involvement and may foster an environment for metastasis to occur. Moving forward, we are currently translating these findings into fresh sentinel lymph nodes obtained from patients in order to elucidate the role of melanoma-derived vesicles in metastasis. Understanding this mechanism may yield valuable insight as we seek to develop efficacious immunotherapies targeting nodal metastasis. Citation Format: Rachel Goldenstein, Wendy Nevala, Svetomir N. Markovic. Melanoma-derived nanovesicles as drivers of immunosuppression. [abstract]. In: Proceedings of the AACR Special Conference: Tumor Immunology and Immunotherapy: A New Chapter; December 1-4, 2014; Orlando, FL. Philadelphia (PA): AACR; Cancer Immunol Res 2015;3(10 Suppl):Abstract nr A70.

Tumor associated PD-L1 expression pattern in microscopically tumor positive sentinel lymph nodes in patients with melanoma.

BackgroundCharacterization of PD-L1 expression within clinically/radiologically negative but microscopically tumor positive sentinel lymph nodes (SLN) is important to our understanding of the relevance of this immune checkpoint pathway for adjuvant therapy.MethodsPatients included had primary cutaneous melanoma, Breslow thickness of 2.01–4.0 or >4 mm with or without tumor ulceration (T3a, T3b, T4a, T4b). All patients had microscopically tumor positive SLN. Hematoxylin and eosin (H&E) staining was performed, followed by PD-L1 immunohistochemical (IHC) staining using a preliminary IHC assay with anti-PD-L1 antibody clone 22C3. The slides were separately evaluated by two pathologists (JY and CG). Samples containing metastatic melanoma lesions were scored separately for PD-L1 expression in intratumoral and peritumoral locations, by utilizing two scoring methods.ResultsTwenty-four patients where metastatic melanoma presence in the SLN was confirmed by H&E review of the cut sections were included in the final analysis of PD-L1 expression. SLN tumor size ranged from 1 to 2 mm. For three patients, the melanin content was too high to confidently assign a PD-L1 score. For the remaining 21 patients, all had some evidence of either intratumoral or peritumoral PD-L1 expression. The frequency of intratumoral tumor-associated PD-L1 expression was: 0 % of tumor cells (3 pts, 14 %); <1 % (5 pts, 24 %); 1–10 % (6 pts, 29 %) and >10 % (7 pts, 33 %).ConclusionsTumor-associated PD-L1 expression is readily detectable within melanoma micrometastases in the SLN of the majority of patients. These results support the testing of a therapeutic role for PD1/PD-L1 inhibition in the adjuvant setting, targeting melanoma micrometastases.

Fusion of Freehand SPECT and Ultrasound to Perform Ultrasound-Guided Fine-Needle Aspiration Cytology of Sentinel Nodes in Head and Neck Cancer.

Criteria for ultrasound-guided fine-needle aspiration cytology (USgFNAC) for the detection of occult lymph node metastasis in patients with clinically negative head and neck cancer are based on the morphology of cervical lymph nodes. To improve the selection of lymph nodes for USgFNAC, we examined the feasibility of fused freehand single-photon emission tomography ultrasound-guided fine-needle cytology (freehand SPECT-USgFNAC) of sentinel nodes in patients with early stage oral and head and neck skin cancer. Six patients with early-stage head and neck cancer (4 oral and 2 head and neck skin cancers) and a clinically negative neck who were scheduled for transoral or local excision and a sentinel node procedure underwent USgFNAC and freehand SPECT-USgFNAC preoperatively. All freehand SPECT sonographic examinations were technically successful in terms of identifying sentinel nodes. All aspirates of sentinel nodes obtained by freehand SPECT-USgFNAC contained substantial radioactivity, confirming puncture of the sentinel nodes. USgFNAC evaluated 13 lymph nodes; freehand SPECT-USgFNAC, 19 nodes; and sentinel node biopsy, 13 nodes. Three sentinel nodes were histopathologically positive and were selected for aspiration cytology by freehand SPECT-USgFNAC, but not by conventional ultrasound. The cytologic examination findings of the aspirations were negative or inconclusive. Freehand SPECT ultrasound can identify sentinel nodes and could potentially improve USgFNAC in patients with head and neck cancer by better selection of lymph nodes at highest risk of having metastases (sentinel nodes), but its sensitivity is limited by sampling error and insufficient aspirated material for cytology.