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European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-05-2022 | Computed Tomography | Original Article

Within-patient comparison between [⁶⁸Ga]Ga-tilmanocept PET/CT lymphoscintigraphy and [^99mTc]Tc-tilmanocept lymphoscintigraphy for sentinel lymph node detection in oral cancer: a pilot study

Authors: Rutger Mahieu, Dominique N. V. Donders, Gerard C. Krijger, F. F. Tessa Ververs, Remmert de Roos, John L. M. M. Bemelmans, Rob van Rooij, Remco de Bree, Bart de Keizer

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 6/2022

Abstract

Purpose

To compare sentinel lymph node (SLN) identification using [⁶⁸Ga]Ga-tilmanocept PET/CT lymphoscintigraphy to [^99mTc]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 [^99mTc]Tc-tilmanocept without the interference of [⁶⁸Ga]Ga-tilmanocept in these patients.

Methods

This prospective within-patient comparison pilot study evaluated SLN identification by [⁶⁸Ga]Ga-tilmanocept PET/CT lymphoscintigraphy compared to conventional lymphoscintigraphy using [^99mTc]Tc-tilmanocept (~ 74 MBq) in 10 early-stage oral cancer patients scheduled for SLN biopsy. After conventional [^99mTc]Tc-tilmanocept lymphoscintigraphy, patients underwent peritumoral administration of [⁶⁸Ga]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.

Results

A total of 24 SLNs were identified by [^99mTc]Tc-tilmanocept lymphoscintigraphy, all except one were also identified by [⁶⁸Ga]Ga-tilmanocept PET/CT lymphoscintigraphy. [⁶⁸Ga]Ga-tilmanocept PET/CT lymphoscintigraphy identified 4 additional SLNs near the injection site, of which two harbored metastases. Lymphatic vessels transporting [⁶⁸Ga]Ga-tilmanocept were identified by PET/CT lymphoscintigraphy in 80% of patients, while draining lymphatic vessels were visualized by [^99mTc]Tc-tilmanocept lymphoscintigraphy in 20% of patients. Of the 33 SLNs identified by [⁶⁸Ga]Ga-tilmanocept PET/CT lymphoscintigraphy, 30 (91%) were intraoperatively localized under conventional gamma-probe guidance.

Conclusion

[⁶⁸Ga]Ga-tilmanocept PET/CT lymphoscintigraphy provided more accurate identification of SLNs and improved visualization of lymphatic vessels compared to [^99mTc]Tc-tilmanocept lymphoscintigraphy. When combined with peritumoral administration of [^99mTc]Tc-tilmanocept, SLNs detected by [⁶⁸Ga]Ga-tilmanocept PET/CT lymphoscintigraphy can be reliably localized during surgery under conventional gamma-probe guidance.

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Title: Within-patient comparison between [68Ga]Ga-tilmanocept PET/CT lymphoscintigraphy and [99mTc]Tc-tilmanocept lymphoscintigraphy for sentinel lymph node detection in oral cancer: a pilot study
Authors: Rutger Mahieu
Dominique N. V. Donders
Gerard C. Krijger
F. F. Tessa Ververs
Remmert de Roos
John L. M. M. Bemelmans
Rob van Rooij
Remco de Bree
Bart de Keizer
Publication date: 01-05-2022
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Oral Cancer
Metastasis
Computed Tomography
Neck Dissection
Positron Emission Tomography
Oral Cavity Carcinoma
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 6/2022
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-021-05645-0

At a glance: The STEP trials

Springer Medicine

Within-patient comparison between [⁶⁸Ga]Ga-tilmanocept PET/CT lymphoscintigraphy and [^99mTc]Tc-tilmanocept lymphoscintigraphy for sentinel lymph node detection in oral cancer: a pilot study

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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