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Sentinel lymph node detection in oral cancer: a within-patient comparison between [99mTc]Tc-tilmanocept and [99mTc]Tc-nanocolloid.

Authors
  • den Toom, Inne J1
  • Mahieu, Rutger1
  • van Rooij, Rob2
  • van Es, Robert J J1
  • Hobbelink, Monique G G2
  • Krijger, Gerard C2
  • Tijink, Bernard M1
  • de Keizer, Bart2
  • de Bree, Remco3
  • 1 Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, the Netherlands, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands. , (Netherlands)
  • 2 Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, the Netherlands, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands. , (Netherlands)
  • 3 Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, the Netherlands, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands. [email protected] , (Netherlands)
Type
Published Article
Journal
European Journal of Nuclear Medicine
Publisher
Springer-Verlag
Publication Date
Mar 01, 2021
Volume
48
Issue
3
Pages
851–858
Identifiers
DOI: 10.1007/s00259-020-04984-8
PMID: 32839855
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Sentinel lymph node (SLN) biopsy has proven to reliably stage the clinically negative neck in early-stage oral squamous cell carcinoma (OSCC). [99mTc]Tc-tilmanocept may be of benefit in OSCC with complex lymphatic drainage patterns and close spatial relation to SLNs. A prospective within-patient evaluation study was designed to compare [99mTc]Tc-tilmanocept with [99mTc]Tc-nanocolloid for SLN detection. A total of 20 patients with early-stage OSCC were included, who underwent lymphoscintigraphy with both tracers. Both lymphoscintigraphic images of each patient were evaluated for SLN detection and radiotracer distribution at 2-4 h post-injection. The injection site's remaining radioactivity was significantly lower for [99mTc]Tc-tilmanocept (29.9%), compared with [99mTc]Tc-nanocolloid (60.9%; p < 0.001). Radioactive uptake in SLNs was significantly lower for [99mTc]Tc-tilmanocept (1.95%) compared with [99mTc]Tc-nanocolloid (3.16%; p = 0.010). No significant difference was seen in SLN to injection site ratio in radioactivity between [99mTc]Tc-tilmanocept (0.066) and [99mTc]Tc-nanocolloid (0.054; p = 0.232). A median of 3.0 and 2.5 SLNs were identified with [99mTc]Tc-tilmanocept and [99mTc]Tc-nanocolloid, respectively (p = 0.297). Radioactive uptake in higher echelon nodes was not significantly different between [99mTc]Tc-tilmanocept (0.57%) and [99mTc]Tc-nanocolloid (0.86%) (p = 0.052). A median of 2.0 and 2.5 higher echelon nodes was identified with [99mTc]Tc-tilmanocept and [99mTc]Tc-nanocolloid, respectively (p = 0.083). [99mTc]Tc-tilmanocept had a higher injection site clearance, but at the same time a lower uptake in the SLN, resulting in an SLN to injection site ratio, which was not significantly different from [99mTc]Tc-nanocolloid. The relatively low-radioactive uptake in SLNs of [99mTc]Tc-tilmanocept may limit intraoperative detection of SLNs, but can be overcome by a higher injection dose.

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