Vidal-Sicart S, Vera D R, Valdés Olmos R A
Servei de Medicina Nuclear, Hospital Clínic, Barcelona, España; Servei de Medicina Nuclear, IMI, Parc de Salut Mar, Barcelona, España.
Department of Radiology, University of California San Diego (UCSD), San Diego, California, Estados Unidos.
Rev Esp Med Nucl Imagen Mol (Engl Ed). 2018 Nov-Dec;37(6):373-379. doi: 10.1016/j.remn.2018.09.001. Epub 2018 Nov 5.
Sentinel lymph node (SLN) biopsy is now the standard of care for regional staging in several solid tumors. The interstitial administration of a radiotracer around the primary tumor provide the possibility to sequentially obtain images with a gamma camera and visualize lymphatic mapping and the SLN. There is, however, a large geographical variability in those radiotracers and nanocolloids ranging from 15-100nm which are most widely employed in Europe, while filtered and unfiltered Tc-sulfur colloid (range 20-1000nm) is usually used in the USA with different drawbacks in its use. The new radiotracer Tc-Tilmanocept, designed specifically for the identification of SLNs and recently becoming commercially available in USA and Europe, appears to have the potency to overcome the shortcomings described for the conventional radiotracers used until now for SLN biopsy and at the same time to transform current imaging paradigms. After delineating the challenges for the next generation of radiotracers, this paper discusses the properties of Tc-Tilmanocept, its validation process for SLN biopsy and its emerging clinical applications in various malignancies.
前哨淋巴结（SLN）活检现已成为多种实体瘤区域分期的标准治疗方法。在原发性肿瘤周围间质注射放射性示踪剂，使得通过γ相机依次获取图像并可视化淋巴引流图谱和前哨淋巴结成为可能。然而，在欧洲广泛使用的那些粒径范围为15至100纳米的放射性示踪剂和纳米胶体存在很大的地域差异，而在美国通常使用经过过滤和未经过滤的锝硫胶体（粒径范围20至1000纳米），其使用存在不同缺点。新型放射性示踪剂锝替莫西芬，专门设计用于识别前哨淋巴结，最近在美国和欧洲上市，似乎有能力克服迄今为止用于前哨淋巴结活检的传统放射性示踪剂所描述的缺点，同时改变当前的成像模式。在阐述了下一代放射性示踪剂面临的挑战之后，本文讨论了锝替莫西芬的特性、其在前哨淋巴结活检中的验证过程及其在各种恶性肿瘤中的新兴临床应用。
