Sentinel lymph node detection in oral cancer: a within-patient comparison between [ 99m Tc]Tc-tilmanocept and [ 99m Tc]T
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ORIGINAL ARTICLE
Sentinel lymph node detection in oral cancer: a within-patient comparison between [99mTc]Tc-tilmanocept and [99mTc] Tc-nanocolloid Inne J. den Toom 1 & Rutger Mahieu 1 & Rob van Rooij 2 & Robert J. J. van Es 1 & Monique G. G. Hobbelink 2 & Gerard C. Krijger 2 & Bernard M. Tijink 1 & Bart de Keizer 2 & Remco de Bree 1 Received: 25 May 2020 / Accepted: 29 July 2020 # The Author(s) 2020
Abstract 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]Tcnanocolloid 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]Tcnanocolloid, 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. Keywords Oral cancer . Sentinel lymph nodes . Lymphatic metastasis . Lymphoscintigraphy . [99mTc]Tc-tilmanocept
This article is part of the Topical Collection on Oncology - Head and Neck Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00259-020-04984-8) contains supplementary material, which is available to authorized users. * Remco de Bree [email protected] 1
Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, the Netherlands, Heidelberglaan 100, 3584 CX Utrecht, Netherlands
2
Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, the Netherlands, Heidelberglaan 100, 3584 C
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