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Lymphoscintigraphy Using Tilmanocept Detects Multiple Sentinel Lymph Nodes in Melanoma Patients.

Daniel M Balkin1, Gregory J Tranah2, Frederick Wang3

  • 1Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.

Cancer Control : Journal of the Moffitt Cancer Center
|January 27, 2023
PubMed
Summary

Technetium-99m-labeled Tilmanocept effectively identifies multiple sentinel lymph nodes (SLNs) in most melanoma patients, aiding in staging. This imaging agent targets CD206 receptors on immune cells within lymph nodes.

Keywords:
melanoma lymphatic drainagemelanoma sentinel lymph nodestilmanocept (lymphoseek)

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Area of Science:

  • Oncology
  • Nuclear Medicine
  • Immunology

Background:

  • Technetium-99m-labeled Tilmanocept, a mannose-based agent, targets CD206 receptors on macrophages and dendritic cells.
  • These immune cells are abundant in lymph nodes, making them ideal targets for imaging.

Purpose of the Study:

  • To evaluate the drainage patterns of Technetium-99m-labeled Tilmanocept to sentinel lymph nodes (SLNs) in melanoma patients.
  • To assess the utility of the 10% rule in identifying SLNs with this agent.

Main Methods:

  • Multi-center retrospective review of 564 cutaneous melanoma patients undergoing SLN biopsy.
  • Use of Technetium-99m-labeled Tilmanocept for preoperative lymphoscintigraphy between 2008 and 2014.
  • Statistical analysis of drainage patterns and SLN positivity.

Main Results:

  • 78% of patients had more than one SLN identified by Technetium-99m-labeled Tilmanocept.
  • Multiple draining basins were observed, particularly for head/neck (36.5%) and trunk (36.4%) primary sites.
  • A positive SLN rate of 8% was found, with positivity associated with younger age, greater Breslow depth, and higher AJCC stage.

Conclusions:

  • Technetium-99m-labeled Tilmanocept effectively detects multiple SLNs in the majority of melanoma patients.
  • The findings support the use of this agent and the 10% rule for SLN mapping in melanoma.
  • SLN status is a critical prognostic factor in melanoma.