Mahieu Rutger, Donders Dominique N V, Krijger Gerard C, Ververs F F Tessa, de Roos Remmert, Bemelmans John L M M, van Rooij Rob, de Bree Remco, de Keizer Bart
Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
Eur J Nucl Med Mol Imaging. 2022 May;49(6):2023-2036. doi: 10.1007/s00259-021-05645-0. Epub 2021 Dec 28.
To compare sentinel lymph node (SLN) identification using [Ga]Ga-tilmanocept PET/CT lymphoscintigraphy to [Tc]Tc-tilmanocept lymphoscintigraphy (including SPECT/CT) in early-stage oral cancer. Furthermore, to assess whether reliable intraoperative SLN localization can be performed with a conventional portable gamma-probe using [Tc]Tc-tilmanocept without the interference of [Ga]Ga-tilmanocept in these patients.
This prospective within-patient comparison pilot study evaluated SLN identification by [Ga]Ga-tilmanocept PET/CT lymphoscintigraphy compared to conventional lymphoscintigraphy using [Tc]Tc-tilmanocept (~ 74 MBq) in 10 early-stage oral cancer patients scheduled for SLN biopsy. After conventional [Tc]Tc-tilmanocept lymphoscintigraphy, patients underwent peritumoral administration of [Ga]Ga-tilmanocept (~ 10 MBq) followed by PET/CT acquisition initiated 15 min after injection. Intraoperative SLN localization was performed under conventional portable gamma-probe guidance the next day; the location of harvested SLNs was correlated to both lymphoscintigraphic images in each patient.
A total of 24 SLNs were identified by [Tc]Tc-tilmanocept lymphoscintigraphy, all except one were also identified by [Ga]Ga-tilmanocept PET/CT lymphoscintigraphy. [Ga]Ga-tilmanocept PET/CT lymphoscintigraphy identified 4 additional SLNs near the injection site, of which two harbored metastases. Lymphatic vessels transporting [Ga]Ga-tilmanocept were identified by PET/CT lymphoscintigraphy in 80% of patients, while draining lymphatic vessels were visualized by [Tc]Tc-tilmanocept lymphoscintigraphy in 20% of patients. Of the 33 SLNs identified by [Ga]Ga-tilmanocept PET/CT lymphoscintigraphy, 30 (91%) were intraoperatively localized under conventional gamma-probe guidance.
[Ga]Ga-tilmanocept PET/CT lymphoscintigraphy provided more accurate identification of SLNs and improved visualization of lymphatic vessels compared to [Tc]Tc-tilmanocept lymphoscintigraphy. When combined with peritumoral administration of [Tc]Tc-tilmanocept, SLNs detected by [Ga]Ga-tilmanocept PET/CT lymphoscintigraphy can be reliably localized during surgery under conventional gamma-probe guidance.
比较[镓]Ga-替莫西芬PET/CT淋巴闪烁成像与[锝]Tc-替莫西芬淋巴闪烁成像（包括SPECT/CT）在早期口腔癌中对前哨淋巴结（SLN）的识别情况。此外，评估在这些患者中，使用[锝]Tc-替莫西芬时，能否在不受到[镓]Ga-替莫西芬干扰的情况下，通过传统便携式γ探测器进行可靠的术中SLN定位。
这项前瞻性患者自身对照的试点研究评估了10例计划进行SLN活检的早期口腔癌患者中，[镓]Ga-替莫西芬PET/CT淋巴闪烁成像与使用[锝]Tc-替莫西芬（约74MBq）的传统淋巴闪烁成像对SLN的识别情况。在进行传统的[锝]Tc-替莫西芬淋巴闪烁成像后，患者在肿瘤周围注射[镓]Ga-替莫西芬（约10MBq），注射后15分钟开始进行PET/CT采集。次日在传统便携式γ探测器引导下进行术中SLN定位；将切除的SLN位置与每位患者的淋巴闪烁成像图像进行关联。
[锝]Tc-替莫西芬淋巴闪烁成像共识别出24个SLN，除1个外，其余所有SLN也被[镓]Ga-替莫西芬PET/CT淋巴闪烁成像识别。[镓]Ga-替莫西芬PET/CT淋巴闪烁成像在注射部位附近又识别出4个SLN，其中2个有转移灶。PET/CT淋巴闪烁成像在80%的患者中识别出运输[镓]Ga-替莫西芬的淋巴管，而[锝]Tc-替莫西芬淋巴闪烁成像在20%的患者中显示出引流淋巴管。在[镓]Ga-替莫西芬PET/CT淋巴闪烁成像识别出的33个SLN中，30个（91%）在传统γ探测器引导下术中被定位。
与[锝]Tc-替莫西芬淋巴闪烁成像相比，[镓]Ga-替莫西芬PET/CT淋巴闪烁成像能更准确地识别SLN，并改善淋巴管的可视化。当与肿瘤周围注射[锝]Tc-替莫西芬相结合时，[镓]Ga-替莫西芬PET/CT淋巴闪烁成像检测到的SLN在传统γ探测器引导下的手术中能够可靠地定位。
