Adequate staging and treatment of the neck in squamous cell carcinoma of the oral cavity and oropharynx (OSCC) is of paramount importance. Elective neck dissection (END) of the clinical N0-neck is widely advocated as neck treatment. With regard to the prevalence of 20–40% of occult neck metastases found in the ND specimens, the majority of patients undergo surgery of the lymphatic drainage basin without therapeutic benefit. Sentinel node biopsy (SNB) has been shown to be a safe, reliable and accurate alternative treatment modality for selected patients. Using this technique, lymphatic mapping is crucial. Previous reports suggested a benefit of single photon emission computed tomography with CT (SPECT/CT) over dynamic planar lymphoscintigraphy (LS) alone. SPECT/CT allows the surgeon for better topographical orientation and delineation of sentinel lymph nodes (SLN’s) against surrounding structures. Additionally, SPECT/CT has the potential to detect more SLN’s which might harbour occult disease, than LS. SPECT/CT is recommended to be used routinely, although SPECT/CT is not indispensable for successful SNB. 1. Background Squamous cell carcinoma of the oral cavity and oropharynx (OSCC) accounts for one of the most common cancers worldwide, with more than a quarter million new cases annually [1]. The presence or absence of lymph node involvement is of paramount importance for prognosis and therapy decision [2, 3]. Therefore, an adequate staging and management of the neck is needed. The most challenging issue remains the treatment of the clinically and radiologically negative neck. Most centers throughout the world advocate elective neck dissection (END) for histopathologic staging and removal of microscopic disease in this situation. With regard to the prevalence of 20%–40% of occult neck metastases found in the neck dissection specimens, the majority of patients undergo surgery of the lymphatic drainage basin without therapeutic benefit. Sentinel node biopsy (SNB) has been shown to be very accurate in selecting patients who benefit from elective neck treatment and sparing the costs and morbidity to the others. Detection of the sentinel nodes by lymphatic mapping is crucial with this technique. Single-photon emission computed tomography with CT (SPECT/CT) has been recently introduced to enhance the diagnostic accuracy of preoperative lymphoscintigraphy. 2. Sentinel Node Biopsy By definition, the sentinel lymph node (SLN) is the first draining lymph node to receive lymphatic drainage from a primary tumor of a specific site [4]. In case of lymphatic spread,
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