Department of Surgical Oncology and Head and Neck Surgery, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.
Department of Nuclear Medicine, Westmead Hospital, Sydney, New South Wales, Australia.
ANZ J Surg. 2022 Oct;92(10):2607-2612. doi: 10.1111/ans.17868. Epub 2022 Jul 18.
Sentinel lymph node biopsy (SLNB) has been pivotal for pathological assessment of nodal status in cutaneous melanoma (CM) and oral cavity squamous cell carcinoma (OCSCC) thus crucial for staging. An ideal agent for lymphatic mapping should have a standardized preparation, appropriate accumulation in first-echelon nodes and no side effects. Tilmanocept, a CD206-receptor targeted novel radiotracer fulfils these properties. This study investigated Tilmanocept for lymphoscintigraphy and intraoperative identification of sentinel lymph nodes (SLN) in CM and OCSCC.
This prospective cross sectional study examined patients who presented to Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney. Patients had biopsy proven tumours with clinically and radiologically negative regional lymph nodes. Tilmanocept guided lymphoscintigraphy was followed by intraoperative SLNs identification via handheld gamma probe. Primary endpoints were detection and retrieval rate of SLNs while secondary endpoints included pathological status of SLNs.
Thirty-five patients were included (26 with CM and 9 with OCSCC) with the most common primary tumour site for CM on the extremities (33.3%). Lymphoscintigraphy with Tilmanocept identified at least 1 SLN (sensitivity 100%) in all patients. SLNs were retrieved in all of patients intraoperatively (100% retrieval rate) with positive nodes found in 20% of patients. Tilmanocept also demonstrated 100% tissue specificity, with lymph nodal tissue confirmed histologically, with no false positives.
Tilmanocept is a reliable radiotracer for assessing the nodal status in patients with CM and OCSCC. Our group is the first to evaluate the use of Tilmanocept in the Australian setting, adding to the limited studies worldwide.
前哨淋巴结活检（SLNB）对皮肤黑色素瘤（CM）和口腔鳞状细胞癌（OCSCC）的淋巴结状态的病理评估至关重要，因此对分期至关重要。用于淋巴作图的理想试剂应具有标准化的制剂，在第一级淋巴结中的适当积累，并且没有副作用。Tilmanocept 是一种新型的 CD206 受体靶向放射性示踪剂，具有这些特性。本研究调查了 Tilmanocept 在 CM 和 OCSCC 中的淋巴闪烁显像和术中前哨淋巴结（SLN）的识别。
这项前瞻性的病例研究检查了在悉尼 Westmead 医院 Crown Princess Mary 癌症中心就诊的患者。患者具有经活检证实的肿瘤，且临床和影像学上无区域淋巴结转移。在进行 Tilmanocept 引导的淋巴闪烁显像后，通过手持式伽马探针进行术中 SLN 识别。主要终点是 SLN 的检测和检索率，次要终点包括 SLN 的病理状态。
共纳入 35 例患者（26 例 CM 和 9 例 OCSCC），CM 最常见的原发性肿瘤部位在四肢（33.3%）。所有患者的 Tilmanocept 淋巴闪烁显像均至少识别出 1 个 SLN（敏感性 100%）。所有患者均在术中成功检索到 SLN（100%检索率），其中 20%的患者发现阳性淋巴结。Tilmanocept 还显示出 100%的组织特异性，组织学证实为淋巴结组织，无假阳性。
Tilmanocept 是一种可靠的示踪剂，可用于评估 CM 和 OCSCC 患者的淋巴结状态。我们的研究小组是第一个在澳大利亚评估 Tilmanocept 应用的小组，为全球有限的研究提供了补充。
