Abstract
PurposeSentinel 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.MethodsA 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.ResultsThe 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.
Highlights
The sentinel lymph node biopsy (SLNB) procedure is a diagnostic staging method that is applied in a variety of tumour types, including oral squamous cell carcinoma (OSCC)
This phenomenon is evident in floor of mouth tumours, and multiple studies demonstrated a lower accuracy of the SLNB procedure in floor of mouth tumours compared with other tumour locations in the oral cavity [5,6,7,8]
We showed a significantly higher injection site clearance for [99mTc]Tc-tilmanocept and a significantly lower uptake in the sentinel lymph nodes’ (SLN) in comparison with [99mTc]Tc-nanocolloid
Summary
The sentinel lymph node biopsy (SLNB) procedure is a diagnostic staging method that is applied in a variety of tumour types, including oral squamous cell carcinoma (OSCC). One of the most frequently mentioned difficulties of this procedure occurs when the injection site around the primary tumour produces a large hotspot on lymphoscintigraphy, possibly hiding SLN(s) in close proximity of the primary tumour, usually referred as ‘shine through’ phenomenon (Fig. 1). This phenomenon is evident in floor of mouth tumours, and multiple studies demonstrated a (significantly) lower accuracy of the SLNB procedure in floor of mouth tumours compared with other tumour locations in the oral cavity [5,6,7,8]. Second echelon lymph nodes may erroneously be considered SLNs, resulting in an unnecessary extension of the surgical procedure
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