Tc-99m tilmanocept versus Tc-99m sulfur colloid in breast cancer sentinel lymph node identification: Results from a randomized, blinded clinical trial

J Surg Oncol. 2017 Dec;116(7):819-823. doi: 10.1002/jso.24735. Epub 2017 Jul 10.

Abstract

Introduction: No prior trials have compared sentinel lymph node (SLN) identification outcomes between Tc-99m tilmanocept (TcTM) and Tc-99m sulfur colloid (TcSC) in breast cancer (BC).

Methods: We report on the secondary outcomes from a randomized, double-blinded, single surgeon clinical trial comparing post-injection site pain between TcTM and TcSC. Patients were randomized to receive a preoperative single, peritumoral intradermal injection of TcTM or TcSC. The number of total, "hot", and blue nodes detected and removed were compared between groups.

Results: Fifty-two (27-TcSC and 25-TcTM) patients were enrolled and underwent definitive surgical treatment. At least one "hot" SLN was detected in all patients. Three (5.8%) patients had a disease positive-SLN. The total number of SLNs removed was 61 (mean 2.26 (standard deviation (SD) 0.90)) in the TcSC group and 54 (mean 2.16 (SD 0.90)) in the TcTM group, P = 0.69. The total number of "hot" nodes in the TcSC group was 1.96 (SD 0.76) compared to 2.04 (SD 0.73) in the TcTM group, P = 0.71.

Conclusions: The number of identified SLNs did not differ significantly between TcTM and TcSC. Given that no significant technical advantages exist between the two agents, surgeons should choose a radiopharmaceutical based on cost and side effect profile.

Keywords: breast cancer; lymphatic mapping; sentinel node biopsy; sulfur colloid; tilmanocept.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Breast Neoplasms / diagnostic imaging*
  • Breast Neoplasms / pathology
  • Dextrans*
  • Double-Blind Method
  • Female
  • Humans
  • Lymphatic Metastasis / diagnostic imaging
  • Mannans*
  • Middle Aged
  • Radionuclide Imaging / methods
  • Radiopharmaceuticals*
  • Sentinel Lymph Node / diagnostic imaging*
  • Sentinel Lymph Node Biopsy / methods*
  • Technetium Tc 99m Pentetate / analogs & derivatives*
  • Technetium Tc 99m Sulfur Colloid*

Substances

  • Dextrans
  • Mannans
  • Radiopharmaceuticals
  • technetium-diethylenetriaminepentaacetic acid-mannosyl-dextran
  • Technetium Tc 99m Sulfur Colloid
  • Technetium Tc 99m Pentetate