Academic Surgeon-Scientist Research Scholarship - 2018

Lymphotropic magnetic iron-core nano tracers for sentinel lymph node mapping in oral squamous cell carcinoma
Dr Giri Krishnan

Project Description

Squamous cell carcinoma (SCC) of the oral cavity is an aggressive malignancy with a tendency to spread to lymph nodes (LNs) in the neck. Accurate detection of positive cervical LNs is critical because this regional involvement is associated with a 50% decrease in survival. The overall rate of occult LN metastases in oral SCC is 24.8%, and as such, neck dissection is the gold standard for both staging and treating this disease. Sentinel lymph node biopsy (SLNB) is an alternative to neck dissection to identify occult cervical metastases, and is currently performed using a combination of a handheld gamma probe and nuclear lymphoscintigraphy after interstitial administration of radiotracers around the primary tumour. While this is practiced commonly in the management of breast cancer and melanoma, it’s adoption for oral cancer has been limited due to poor accuracy of this technique in this anatomical area relating to a lack of spatial resolution and a ‘shine through effect’ between the floor of the mouth and the neck.

The purpose of this study is to evaluate the accuracy of a new magnetic SLN mapping technology comprising refined iron-core mannose-targeted magnetic nanno tracers, quasi-real time MRI and a uniquely designed handheld magnetometer probe. We hypothesise that this technology is ideal for preoperative mapping and intraoperative detection of SLNs in head and neck cancer and may avoid the need for neck dissections in patients with clinically negative neck disease, leading to decreased treatment morbidity for this patient cohort.

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