Nuclear Medicine Department, Hospital Clínic Barcelona, Barcelona, Spain
Nuclear Medicine Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
J Nucl Med. 2021 May 10;62(5):620-627. doi: 10.2967/jnumed.120.252064. Epub 2020 Oct 9.
Tc-tilmanocept is a novel radiopharmaceutical for sentinel lymph node (SLN) biopsy in breast cancer. Our aim was to describe results with Tc-tilmanocept in a heterogeneous group of breast cancer patients scheduled for SLN biopsy. Radiotracer preparation followed the manufacturer's indications. Local protocols for SLN detection within 9 participant centers were not changed for the entire duration of the study. In total, 344 patients with T1-T4, N0-N2 breast cancer (352 lesions) were included. Superficial (intradermal or periareolar) or deep (peritumoral or intratumoral) injections were performed. The doses were adjusted depending on the scheduled time for surgery. Lymphoscintigraphy was able to depict at least 1 SLN in 339 of 352 breast lesions (96.3%), and the intraoperative SLN detection rate reached 97.2%. On univariable analysis, SLN detection rates did not differ by age, clinical T or N stage, tumor location, histologic subtype, or prior neoadjuvant therapy. Lymphoscintigraphy showed higher SLN detection in patients with a normal weight (body mass index < 25) than in those who were overweight or obese (body mass index ≥ 25), at 99.2% versus 94.6%, respectively ( = 0.031). The proportion of patients with preoperative lymphoscintigraphic detection or excised SLNs was higher with superficial than deep injections. Reinjected cases were significantly lower when superficial injection was chosen first ( < 0.001). Injection site and the tumor markers human epidermal growth factor receptor 2 and estrogen receptor had an impact on preoperative SLN visualization and intraoperative localization. In 80 cases, SLN biopsy resulted in a positive lymph node. During a mean follow-up of 19 mo, no axillary recurrences were observed. Whatever the protocol, Tc-tilmanocept showed good results in a heterogeneous breast cancer population, although the best results were achieved when a superficial injection was chosen.
Tc-tilmanocept 是一种新型放射性核素药物，可用于乳腺癌前哨淋巴结 (SLN) 活检。我们的目的是描述 Tc-tilmanocept 在接受 SLN 活检的异质性乳腺癌患者中的结果。示踪剂制备遵循制造商的说明。在整个研究期间，9 个参与中心的 SLN 检测局部方案并未因研究而改变。共有 344 名 T1-T4、N0-N2 期乳腺癌（352 个病灶）患者纳入研究。行皮内或乳晕旁（浅表注射）或肿瘤周围或肿瘤内（深部注射）注射。剂量根据手术时间进行调整。淋巴闪烁显像术能够在 352 个乳腺癌病灶中的 339 个（96.3%）中至少显示 1 个前哨淋巴结，术中 SLN 检出率达到 97.2%。单变量分析显示，SLN 检出率与年龄、临床 T 或 N 分期、肿瘤位置、组织学亚型或新辅助治疗无关。淋巴闪烁显像术显示，在体重正常（体重指数<25）的患者中，SLN 检出率高于超重或肥胖（体重指数≥25）患者，分别为 99.2%和 94.6%（=0.031）。与深部注射相比，浅表注射时术前淋巴闪烁显像术检测或切除 SLN 的患者比例更高。当首先选择浅表注射时，再次注射的病例明显减少（<0.001）。注射部位和肿瘤标志物人表皮生长因子受体 2 和雌激素受体对术前 SLN 可视化和术中定位有影响。80 例 SLN 活检结果为阳性淋巴结。平均随访 19 个月，未观察到腋窝复发。无论采用何种方案，Tc- tilmanocept 在异质性乳腺癌人群中均显示出良好的结果，尽管当选择浅表注射时，结果最佳。
