99mTc-Tilmanocept performance for sentinel node mapping in breast cancer, melanoma, and head and neck cancer: a systematic review and meta-analysis from a European expert panel

doi:10.1007/s00259-023-06290-5

Meta-Analysis

. 2023 Sep;50(11):3375-3389.

doi: 10.1007/s00259-023-06290-5. Epub 2023 Jun 13.

^99mTc-Tilmanocept performance for sentinel node mapping in breast cancer, melanoma, and head and neck cancer: a systematic review and meta-analysis from a European expert panel

Guido Rovera¹, Elizabeth J de Koster², Vittoria Rufini^{3

4}, Mariella Zollino⁵, Luca Zagaria⁵, Francesco Giammarile⁶, Sergi Vidal-Sicart⁷, Renato Valdés Olmos⁸, Angela Collarino⁵

Affiliations

¹ Nuclear Medicine, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
² Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
³ Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. vittoria.rufini@unicatt.it.
⁴ Section of Nuclear Medicine, University Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, Rome, Italy. vittoria.rufini@unicatt.it.
⁵ Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁶ Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
⁷ Nuclear Medicine Department, Hospital Clinic Barcelona, Universitat de Barcelona, Institut d'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
⁸ Interventional Molecular Imaging & Nuclear Medicine Section, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.

PMID: 37310426
DOI: 10.1007/s00259-023-06290-5

Meta-Analysis

^99mTc-Tilmanocept performance for sentinel node mapping in breast cancer, melanoma, and head and neck cancer: a systematic review and meta-analysis from a European expert panel

Guido Rovera et al. Eur J Nucl Med Mol Imaging. 2023 Sep.

. 2023 Sep;50(11):3375-3389.

doi: 10.1007/s00259-023-06290-5. Epub 2023 Jun 13.

Authors

Guido Rovera¹, Elizabeth J de Koster², Vittoria Rufini^{3

4}, Mariella Zollino⁵, Luca Zagaria⁵, Francesco Giammarile⁶, Sergi Vidal-Sicart⁷, Renato Valdés Olmos⁸, Angela Collarino⁵

Affiliations

¹ Nuclear Medicine, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
² Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
³ Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. vittoria.rufini@unicatt.it.
⁴ Section of Nuclear Medicine, University Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, Rome, Italy. vittoria.rufini@unicatt.it.
⁵ Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁶ Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
⁷ Nuclear Medicine Department, Hospital Clinic Barcelona, Universitat de Barcelona, Institut d'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
⁸ Interventional Molecular Imaging & Nuclear Medicine Section, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.

PMID: 37310426
DOI: 10.1007/s00259-023-06290-5

Abstract

Purpose: Although multiple radiopharmaceuticals are currently available for sentinel node (SN) biopsy, ^99mTc-tilmanocept is of particular interest due to its low molecular weight and specific binding capability for the mannose receptors of lymphatic reticuloendothelial cells. In the current systematic review and meta-analysis, we aimed to provide an update from a European expert panel on the performance of ^99mTc-tilmanocept for SN biopsy.

Methods: A systematic literature search of the PubMed/Medline and Embase databases was performed to identify studies on the use of ^99mTc-tilmanocept for SN identification in oncological patients. The articles' methodological quality was assessed before inclusion. The pooled estimates of the pre-/intraoperative detection rates (DR; proportion of patients with ≥ 1 SN identified) and/or pN + sensitivity (SN + /pN + patients ratio), with 95% confidence intervals (CIs), were calculated for breast cancer, melanoma, and head and neck cancer.

Results: Twenty-four articles were included in the systematic review, and twenty-one provided data for the meta-analysis. According to data availability, the ^99mTc-tilmanocept-estimated pooled preoperative and intraoperative DRs were 0.94 (95%CI, 0.88-1.01) and 0.99 (0.98-1.00) for breast cancer, 0.98 (0.96-0.99) and 1.00 (0.99-1.00) for melanoma, and 0.97 (0.93-1.02) and 0.99 (0.96-1.01) for head and neck carcinoma. Finally, the pooled sensitivity for nodal metastasis in melanoma was 0.97 (95% CI, 0.92-1.03).

Conclusion: ^99mTc-tilmanocept is a promising radiotracer for SN mapping in patients with breast cancer, melanoma, or head and neck cancer. We strongly believe that multicenter trials are still needed to assess if ^99mTc-tilmanocept is superior to other radiotracers used in clinical routine.

Keywords: 99mTc-tilmanocept; Breast cancer; Head and neck cancer; Melanoma; Sentinel node biopsy.

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References

1. Wilhelm AJ, Mijnhout GS, Franssen EJ. Radiopharmaceuticals in sentinel lymph-node detection - an overview. Eur J Nucl Med. 1999;26:S36-42. - DOI - PubMed
1. Giammarile F, Alazraki N, Aarsvold JN, Audisio RA, Glass E, Grant SF, et al. The EANM and SNMMI practice guideline for lymphoscintigraphy and sentinel node localization in breast cancer. Eur J Nucl Med Mol Imaging. 2013;40:1932–47. - DOI - PubMed
1. Bluemel C, Herrmann K, Giammarile F, Nieweg OE, Dubreuil J, Testori A, et al. EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma. Eur J Nucl Med Mol Imaging. 2015;42:1750–66. - DOI - PubMed
1. Giammarile F, Schilling C, Gnanasegaran G, Bal C, Oyen WJG, Rubello D, et al. The EANM practical guidelines for sentinel lymph node localisation in oral cavity squamous cell carcinoma. Eur J Nucl Med Mol Imaging. 2019;46:623–37. - DOI - PubMed
1. Vera DR, Wallace AM, Hoh CK, Mattrey RF. A synthetic macromolecule for sentinel node detection: ^99mTc-DTPA-mannosyl-dextran. J Nucl Med. 2001;42:951–9. - PubMed

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[1] Wilhelm AJ, Mijnhout GS, Franssen EJ. Radiopharmaceuticals in sentinel lymph-node detection - an overview. Eur J Nucl Med. 1999;26:S36-42. - DOI - PubMed

[2] Wilhelm AJ, Mijnhout GS, Franssen EJ. Radiopharmaceuticals in sentinel lymph-node detection - an overview. Eur J Nucl Med. 1999;26:S36-42. - DOI - PubMed

[3] Giammarile F, Alazraki N, Aarsvold JN, Audisio RA, Glass E, Grant SF, et al. The EANM and SNMMI practice guideline for lymphoscintigraphy and sentinel node localization in breast cancer. Eur J Nucl Med Mol Imaging. 2013;40:1932–47. - DOI - PubMed

[4] Giammarile F, Alazraki N, Aarsvold JN, Audisio RA, Glass E, Grant SF, et al. The EANM and SNMMI practice guideline for lymphoscintigraphy and sentinel node localization in breast cancer. Eur J Nucl Med Mol Imaging. 2013;40:1932–47. - DOI - PubMed

[5] Bluemel C, Herrmann K, Giammarile F, Nieweg OE, Dubreuil J, Testori A, et al. EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma. Eur J Nucl Med Mol Imaging. 2015;42:1750–66. - DOI - PubMed

[6] Bluemel C, Herrmann K, Giammarile F, Nieweg OE, Dubreuil J, Testori A, et al. EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma. Eur J Nucl Med Mol Imaging. 2015;42:1750–66. - DOI - PubMed

[7] Giammarile F, Schilling C, Gnanasegaran G, Bal C, Oyen WJG, Rubello D, et al. The EANM practical guidelines for sentinel lymph node localisation in oral cavity squamous cell carcinoma. Eur J Nucl Med Mol Imaging. 2019;46:623–37. - DOI - PubMed

[8] Giammarile F, Schilling C, Gnanasegaran G, Bal C, Oyen WJG, Rubello D, et al. The EANM practical guidelines for sentinel lymph node localisation in oral cavity squamous cell carcinoma. Eur J Nucl Med Mol Imaging. 2019;46:623–37. - DOI - PubMed

[9] Vera DR, Wallace AM, Hoh CK, Mattrey RF. A synthetic macromolecule for sentinel node detection: ^99mTc-DTPA-mannosyl-dextran. J Nucl Med. 2001;42:951–9. - PubMed

[10] Vera DR, Wallace AM, Hoh CK, Mattrey RF. A synthetic macromolecule for sentinel node detection: ^99mTc-DTPA-mannosyl-dextran. J Nucl Med. 2001;42:951–9. - PubMed

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^99mTc-Tilmanocept performance for sentinel node mapping in breast cancer, melanoma, and head and neck cancer: a systematic review and meta-analysis from a European expert panel

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^99mTc-Tilmanocept performance for sentinel node mapping in breast cancer, melanoma, and head and neck cancer: a systematic review and meta-analysis from a European expert panel

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