Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Department of Pharmacy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Eur J Nucl Med Mol Imaging. 2024 Jan;51(2):512-520. doi: 10.1007/s00259-023-06449-0. Epub 2023 Sep 29.
Sentinel lymph node (SLN) biopsy is rarely used for thyroid carcinoma staging. This is due to challenges associated with conventional Tc-99m-labeled tracers, often producing a large hotspot at the injection site, potentially hiding nearby SLNs (shine-through effect). The aim of this study was to demonstrate the feasibility and effectiveness of SLN visualization using the new PET tracer [Ga]Ga-tilmanocept.
Patients with thyroid carcinoma underwent ultrasound-guided peritumoral injection of [Ga]Ga-tilmanocept and ICG-[Tc]Tc-nanocolloid. [Ga]Ga-tilmanocept PET/CT scans were conducted at 15 min and 60 min post-injection to visualize the SLNs. SLN biopsy was performed using ICG-[Tc]TC-nanocolloid for intraoperative identification. The corresponding lymph node level was resected for reference.
Seven differentiated thyroid carcinoma (DTC) and 3 medullary thyroid carcinoma (MTC) patients were included, of which 6 were clinically node-negative. The median number of SLNs detected on [Ga]Ga-tilmanocept PET/CT and resected was 3 (range 1-4) and 3 (range 1-5), respectively. Eight SLNs were found on PET/CT in the central compartment and 19 in the lateral compartment. The SLN procedure detected (micro)metastases in all patients except one. Seventeen of 27 pathologically assessed SLNs were positive, 8 negative, and 2 did not contain lymph node tissue, which led to upstaging in 5 out of 6 clinically node-negative patients.
[Ga]Ga-tilmanocept PET/CT identified SLNs in all patients, mainly in the lateral neck. The SLNs were successfully surgically detected and resected using ICG-[Tc]Tc-nanocolloid. This technique has the potential to improve neck staging, enabling more personalized treatment of thyroid cancer according to the lymph node status.
2021-002470-42 (EudraCT).
前哨淋巴结 (SLN) 活检在甲状腺癌分期中很少使用。这是由于与传统 Tc-99m 标记示踪剂相关的挑战所致，这些示踪剂通常在注射部位产生一个大的热点，可能会隐藏附近的 SLN（透照效应）。本研究旨在证明使用新型 PET 示踪剂 [Ga]Ga- tilmanocept 进行 SLN 可视化的可行性和有效性。
甲状腺癌患者接受超声引导下肿瘤周围注射 [Ga]Ga-tilmanocept 和 ICG-[Tc]Tc-纳米胶体。注射后 15 分钟和 60 分钟进行 [Ga]Ga-tilmanocept PET/CT 扫描，以可视化 SLN。使用 ICG-[Tc]TC-纳米胶体进行 SLN 活检以进行术中识别。相应的淋巴结水平被切除以供参考。
纳入了 7 例分化型甲状腺癌 (DTC) 和 3 例髓样甲状腺癌 (MTC) 患者，其中 6 例临床淋巴结阴性。[Ga]Ga-tilmanocept PET/CT 和切除的 SLN 中位数分别为 3（范围 1-4）和 3（范围 1-5）。中央隔室共发现 8 个 SLN，侧隔室共发现 19 个 SLN。SLN 程序在除 1 例患者外的所有患者中均检测到（微）转移。27 个病理评估的 SLN 中，17 个为阳性，8 个为阴性，2 个不含有淋巴结组织，这导致 6 例临床淋巴结阴性患者中有 5 例分期升级。
[Ga]Ga-tilmanocept PET/CT 可在所有患者中识别 SLN，主要位于颈部外侧。使用 ICG-[Tc]Tc-纳米胶体成功地检测和切除了 SLN。该技术有可能改善颈部分期，使甲状腺癌的治疗更加个体化，根据淋巴结状态进行治疗。
2021-002470-42（EudraCT）。
