Head and neck

Vol. 46: Issue 1 - February 2026

Beyond sentinel node biopsy: preliminary results of indocyanine green-guided neck dissection in cN0 tongue cancer

Authors

Luca Calabrese , Luca Gazzini , Marta Tagliabue , Enrico Fazio , Guglielmo Ronzani , Roberto Bruschini , Valeria Navach , Valentina Camesasca , Mohssen Ansarin , Monir Abousiam

Key words: sentinel lymph node biopsy, oral cancer, indocyanine green, lymphoscintigraphy, neck dissection
DOI: 10.14639/0392-100X-A878
Publication Date: 2026-03-09

Abstract

Objective. Neck management in oral cancer is crucial, as regional involvement strongly affects survival. Elective dissection leaves out 10% of recurrences, mainly at levels IV-V or contralateral. Sentinel node biopsy is a different strategy to detect unexpected lymphatic drainage. Our aim is to develop a tumour-specific lymphatic mapping approach for locally-advanced cN0 tongue cancers by combining scintigraphy biopsy with indocyanine green (ICG) guidance.
Methods. In this multicentre prospective pilot study lymphatic drainage was evaluated preoperatively using scintigraphy and intraoperatively with ICG fluorescence. Bilateral neck dissection was first performed removing ICG enhancing nodes, then those identified by gamma probe and lastly the remaining ones.
Results. Nine patients were enrolled. Robbin’s levels mostly enhanced were IB-IIA-III (83%), followed by level IV (66%), IIB (50%) and IA (33%). The ICG method showed a sensitivity of 100%, a positive predictive value of 47% compared to lymphoscintigraphy and of 6.3% compared to metastatic nodes. A negative predictive value of 100% was observed by both.
Conclusions. A tailored lymphography-guided neck dissection could provide an effective lymphatic mapping with any individual variation allowing to overcome the limitations of sentinel biopsy and pitfalls associated with traditional elective treatment.

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Authors

Luca Calabrese - Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy

Luca Gazzini - Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy

Marta Tagliabue - Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Milan, Italy

Enrico Fazio - Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy

Guglielmo Ronzani - tolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Verona, Italy. Corresponding author - guglielmo.ronzanimd@gmail.com

Roberto Bruschini - Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Milan, Italy

Valeria Navach - Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Milan, Italy

Valentina Camesasca - Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Milan, Italy

Mohssen Ansarin - Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Milan, Italy

Monir Abousiam - epartment of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Copyright

Copyright (c) 2026 Società Italiana di Otorinolaringoiatria e chirurgia cervico facciale

How to Cite
Calabrese, L., Gazzini, L., Tagliabue, M., Fazio, E., Ronzani, G., Bruschini, R., Navach, V., Camesasca, V., Ansarin, M., & Abousiam, M. (2026). Beyond sentinel node biopsy: preliminary results of indocyanine green-guided neck dissection in cN0 tongue cancer. ACTA Otorhinolaryngologica Italica, 46(1), 23–33. https://doi.org/10.14639/0392-100X-A878
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