Use of 99mTc-Tilmanocept as a Single Agent for Sentinel Lymph Node Identification in Breast Cancer: A Retrospective Pilot Study

J Nucl Med Technol. 2017 Sep;45(3):181-184. doi: 10.2967/jnmt.117.194415. Epub 2017 Jul 13.

Abstract

99mTc-tilmanocept received recent Food and Drug Administration approval for lymphatic mapping in 2013. However, to our knowledge, no prior studies have evaluated the use of 99mTc-tilmanocept as a single agent in sentinel lymph node (SLN) biopsy in breast cancer. Methods: We executed this retrospective pilot study to assess the ability of 99mTc-tilmanocept to identify sentinel nodes as a single agent in clinically node-negative breast cancer patients. Patients received a single intradermal injection overlying the tumor of either 18.5 MBq (0.5 mCi) of 99mTc-tilmanocept on the day of surgery or 74.0 MBq (2.0 mCi) on the day before surgery by a radiologist. Immediate 3-view lymphoscintigraphy was performed. Intraoperatively, SLNs were identified with a portable γ-probe. A node was classified as hot if the count (per second) of the node was more than 3 times the background count. Descriptive statistics are reported. Results: Nineteen patients underwent SLN biopsy with single-agent 99mTc-tilmanocept. Immediate lymphoscintigraphy identified at least 1 sentinel node in 13 of 17 patients (76.5%). Intraoperatively, at least 1 (mean, 1.7 ± 0.8; range, 1-3) hot node was identified in all patients. Three patients (15.8%) had 1 disease-positive SLN. Conclusion: In this small, retrospective pilot study, 99mTc-tilmanocept performed well as a single agent for intraoperative sentinel node identification in breast cancer. A larger, randomized clinical trial is warranted to compare 99mTc-tilmanocept as a single agent with other radiopharmaceuticals for sentinel node identification in breast cancer.

Keywords: breast cancer; lymphatic mapping; sentinel node biopsy; tilmanocept.

MeSH terms

  • Breast Neoplasms / diagnostic imaging*
  • Breast Neoplasms / pathology*
  • Dextrans*
  • Diagnosis, Differential
  • Female
  • Humans
  • Lymphatic Metastasis
  • Lymphoscintigraphy / methods*
  • Male
  • Mannans*
  • Middle Aged
  • Pilot Projects
  • Radiopharmaceuticals
  • Reproducibility of Results
  • Retrospective Studies
  • Sensitivity and Specificity
  • Sentinel Lymph Node / diagnostic imaging*
  • Sentinel Lymph Node / pathology*
  • Sentinel Lymph Node Biopsy
  • Technetium Tc 99m Pentetate / analogs & derivatives*

Substances

  • Dextrans
  • Mannans
  • Radiopharmaceuticals
  • technetium-diethylenetriaminepentaacetic acid-mannosyl-dextran
  • Technetium Tc 99m Pentetate