Tc‐99m tilmanocept versus Tc‐99m sulfur colloid in breast cancer sentinel lymph node identification: Results from a randomized, blinded clinical trial

Unkart, Jonathan T.; Hosseini, Ava; Wallace, Anne M.

doi:10.1002/jso.24735

Cited by 20 publications

(10 citation statements)

References 12 publications

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“…Additionally, Unkart et al found no statistical differences in breast cancer patients concerning number of hotspots, number of removed SLNs, time to surgical removal, or number of blue nodes for [ 99m Tc]Tc-Tilmanocept compared with [ 99m Tc]Tc-sulphur colloid [23]. However, this study was not especially designed for analyzing differences regarding SLN identification.…”

Section: Discussionmentioning

confidence: 80%

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

Toom

Mahieu

Rooij

et al. 2020

Eur J Nucl Med Mol Imaging

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Purpose 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. Methods 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. Results 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). Conclusion [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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Section: Discussionmentioning

confidence: 80%

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

Toom

Mahieu

Rooij

et al. 2020

Eur J Nucl Med Mol Imaging

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“…In contrast, another study using 99m Tc-tilmanocept observed a reduction of false negative findings to 2.56% [ 18 ], demonstrating better results. However, the difference between 99m Tc-tilmanocept and 99m Tc-sulfur colloid has been part of a randomized, blinded clinical trial in breast cancer [ 22 ]. This study could not find any differences between these tracers.…”

Section: Discussionmentioning

confidence: 99%

Sentinel Lymph Node Biopsy in Early Stages of Oral Squamous Cell Carcinoma Using the Receptor-Targeted Radiotracer 99mTc-Tilmanocept

et al. 2021

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Neck management in patients with early-stage, clinically node-negative oral squamous cell carcinoma (OSCC) remains a matter of discussion. Sentinel lymph node biopsy (SLNB) represents a treatment alternative to avoid elective neck dissection (END) in this cohort and different protocols and tracers exist. Here we present the clinical outcome of SLNB using 99mTc-tilmanocept in a two-day protocol in patients suffering from early-stage OSCC. A total of 13 patients (males: 6; females: 7; mean age: 65.7 years, ranging from 47 to 89 years) were included in this study. Most of the patients suffered from an OSCC of the floor of mouth (n = 6), followed by tongue (n = 5) and upper alveolar crest/hard palate (n = 2). Sentinel lymph nodes (SLNs) were successfully identified in all cases (range: 1–7). The average length of hospital stay was 4.7 days (range: 3–8 days) and mean duration of surgical intervention was 121 min (range: 74–233 min). One patient who suffered from an OSCC of the tongue was sentinel lymph node positive (SLN+). The mean follow-up for all sentinel lymph node negative (SLN-) patients (n = 12) was 20.3 months (range: 10–28 months). No local or nodal recurrences were observed within the observation period. In our patient cohort, SLNB using 99mTc-tilmanocept in a two-day protocol proved to be a reliable and safe staging method for patients suffering from early-stage, clinically node-negative OSCC. These results and their possible superiority to colloid tracers have to be confirmed in a prospective randomized controlled study.

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“…4,5 Historically, the standard radiotracer used in the United States has been Tc-99m sulfur colloid (TcSC), which is passively transported by the lymphatic system based on molecular weight (100-220 nm). 4,6 In contrast, 99mTctilmanocept (TcTM) is a small (7 nm) radiotracer approved by the Food and Drug Administration in 2013 that targets the mannose CD206 receptor within the macrophages of lymph nodes. [5][6][7] In a phase 1 clinical trial in breast cancer patients, TcTM demonstrated faster injection site clearance and equivalent primary sentinel lymph node uptake when compared to TcSC, which has significant implications for surgical planning, patient convenience and health care costs.…”

Section: Introductionmentioning

confidence: 99%

“…4,6 In contrast, 99mTctilmanocept (TcTM) is a small (7 nm) radiotracer approved by the Food and Drug Administration in 2013 that targets the mannose CD206 receptor within the macrophages of lymph nodes. [5][6][7] In a phase 1 clinical trial in breast cancer patients, TcTM demonstrated faster injection site clearance and equivalent primary sentinel lymph node uptake when compared to TcSC, which has significant implications for surgical planning, patient convenience and health care costs. 8 In 2014, technetium TcTM replaced TcSC as the preferred lymphoscintigraphy (LS) agent for melanoma patients at our two institutions.…”

Section: Introductionmentioning

confidence: 99%

How much time is enough? Sentinel lymph node mapping time depends on the radiotracer agent

Eckhoff

Farrow

Silvestri

et al. 2021

Journal of Surgical Oncology

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Background In 2014, technetium‐99m tilmanocept (TcTM) replaced technetium‐99m sulfur colloid (TcSC) as the standard lymphoscintigraphy (LS) mapping agent in melanoma patients undergoing sentinel lymph node biopsy (SLNB). The aim of this study was to examine differences in mapping time, intra‐operative identification of sentinel lymph node (SLN), and false negative rate (FNR) between patients who underwent SLNB with TcTM compared to TcSC. Methods Patients who underwent SLNB between 2010 and 2018 were retrospectively identified. Patient demographic, tumor, and imaging data was stratified by receipt of TcSC (n = 258) or TcTM (n = 133). Student's t test and χ2 test were used to compare characteristics and outcomes. Results Both cohorts were similar in demographic, primary tumor characteristics, and total number of SLN identified (TcTM 3.56 vs. TcSC 3.28, p = 0.244). TcTM was associated with significantly shorter LS mapping times (51.8 vs. 195.1 min, p < 0.01). There was no significant difference in the number of patients with positive SLN (TcTM 11.3 vs. TcSC 17.4%, p = 0.109) and the FNR was similar between both groups (TcTM 25% vs. TcSC 22%). Conclusion TcTM was associated with significantly shorter LS mapping time while identifying similar numbers of SLN. Our results support further study to ensure similar FNR and oncologic outcomes between agents.

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Tc‐99m tilmanocept versus Tc‐99m sulfur colloid in breast cancer sentinel lymph node identification: Results from a randomized, blinded clinical trial

Abstract: The number of identified SLNs did not differ significantly between TcTM and TcSC. Given that no significant technical advantages exist between the two agents, surgeons should choose a radiopharmaceutical based on cost and side effect profile.

Cited by 20 publications

References 12 publications

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

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

Sentinel Lymph Node Biopsy in Early Stages of Oral Squamous Cell Carcinoma Using the Receptor-Targeted Radiotracer 99mTc-Tilmanocept

How much time is enough? Sentinel lymph node mapping time depends on the radiotracer agent

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