Is there more than meets the eye than sentinel node localisation during lymphoscintigraphy mapping? Potential immunologic and therapeutic implications

Excerpt

Sentinel node biopsy (SNB) is included as the standard of care of breast cancer and melanoma, but also of other locations such as head and neck tumours [1‐4]. Accurate staging of early tumours with SNB provides diagnostic and prognostic information based on the stage of the disease and, thus, allows precise treatment planning and patient management. The radiopharmaceuticals used in SNB, when applied as the standard of care, are [^99mTc]Tc-sulphur colloid (TcSC) and [^99mTc]Tc-albumin colloid (TcAC), but other radiopharmaceuticals, such as [^99mTc]Tc-tilmanocept (TcTM), are being studied [1, 2]. Ooms et al. [5] retrospectively analysed 62 patients with cutaneous malignancies of the head that underwent a SNB procedure between 2012 and 2021 and were injected either with TcTM, TcSC, or TcAC. Taking into account the sentinel lymph node (SLN) localisation rate (number of patients with SLNs) and degree (SLN number), among other parameters, TcTM presented similar diagnostic performance to TcSC and TcAC, only finding significant differences in the localisation degree favouring TcTM over TcSC (p = 0.034) and TcAC (p = 0.038) for primary tumours in the anterior head region. The authors concluded that, because TcTM has a higher cost than TcSC and TcAC and a similar performance in detecting SLNs, it cannot replace TcSC and TcAC in all situations. The authors suggested that TcTM could only be recommended in patients with cutaneous malignancies in the anterior head region [5]. However, this suggestion should be verified by further studies, including not only diagnostic studies but also cost-effectiveness analyses comparing TcTM with TcSC and TcAC. …