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. 2022 Oct;92(10):2607-2612.
doi: 10.1111/ans.17868. Epub 2022 Jul 18.

Tilmanocept as a novel tracer for lymphatic mapping and sentinel lymph node biopsy in melanoma and oral cancer

Derek Mwagiru  1 , Pranav Shivashankar  1 , Eva Wong  1 , David Farlow  2 , Brad Cambden  2 , Muzib Abdul-Razak  3
Affiliations

Tilmanocept as a novel tracer for lymphatic mapping and sentinel lymph node biopsy in melanoma and oral cancer

Derek Mwagiru et al. ANZ J Surg. 2022 Oct.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: lymphoscintigram; melanoma; oral cancer; radioactive tracer; sentinel lymph node biopsy.

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Conflict of interest statement

None declared.

Figures

Fig. 1
Fig. 1
Frequency distribution of sentinel lymph nodes on lymphoscintigraphy.
Fig. 2
Fig. 2
Frequency distribution of sentinel lymph nodes retrieved during surgery.
Fig. 3
Fig. 3
Sentinel lymph nodes found in lymphoscintigraphy versus surgery.
See this image and copyright information in PMC

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