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Abstract：
OBJECTIVE: Sentinel lymph node (SLN) biopsy is rarely used for thyroid carcinoma staging. This is due to challenges associated with conventional Tc-99m-labeled tracers, often producing a large hotspot at the injection site, potentially hiding nearby SLNs (shine-through effect). The aim of this study was to demonstrate the feasibility and effectiveness of SLN visualization using the new PET tracer [68Ga]Ga-tilmanocept.
METHODS: Patients with thyroid carcinoma underwent ultrasound-guided peritumoral injection of [68Ga]Ga-tilmanocept and ICG-[99mTc]Tc-nanocolloid. [68Ga]Ga-tilmanocept PET/CT scans were conducted at 15 min and 60 min post-injection to visualize the SLNs. SLN biopsy was performed using ICG-[99mTc]TC-nanocolloid for intraoperative identification. The corresponding lymph node level was resected for reference.
RESULTS: Seven differentiated thyroid carcinoma (DTC) and 3 medullary thyroid carcinoma (MTC) patients were included, of which 6 were clinically node-negative. The median number of SLNs detected on [68Ga]Ga-tilmanocept PET/CT and resected was 3 (range 1-4) and 3 (range 1-5), respectively. Eight SLNs were found on PET/CT in the central compartment and 19 in the lateral compartment. The SLN procedure detected (micro)metastases in all patients except one. Seventeen of 27 pathologically assessed SLNs were positive, 8 negative, and 2 did not contain lymph node tissue, which led to upstaging in 5 out of 6 clinically node-negative patients.
CONCLUSIONS: [68Ga]Ga-tilmanocept PET/CT identified SLNs in all patients, mainly in the lateral neck. The SLNs were successfully surgically detected and resected using ICG-[99mTc]Tc-nanocolloid. This technique has the potential to improve neck staging, enabling more personalized treatment of thyroid cancer according to the lymph node status.
BACKGROUND: 2021-002470-42 (EudraCT).
METHODS: Patients with thyroid carcinoma underwent ultrasound-guided peritumoral injection of [68Ga]Ga-tilmanocept and ICG-[99mTc]Tc-nanocolloid. [68Ga]Ga-tilmanocept PET/CT scans were conducted at 15 min and 60 min post-injection to visualize the SLNs. SLN biopsy was performed using ICG-[99mTc]TC-nanocolloid for intraoperative identification. The corresponding lymph node level was resected for reference.
RESULTS: Seven differentiated thyroid carcinoma (DTC) and 3 medullary thyroid carcinoma (MTC) patients were included, of which 6 were clinically node-negative. The median number of SLNs detected on [68Ga]Ga-tilmanocept PET/CT and resected was 3 (range 1-4) and 3 (range 1-5), respectively. Eight SLNs were found on PET/CT in the central compartment and 19 in the lateral compartment. The SLN procedure detected (micro)metastases in all patients except one. Seventeen of 27 pathologically assessed SLNs were positive, 8 negative, and 2 did not contain lymph node tissue, which led to upstaging in 5 out of 6 clinically node-negative patients.
CONCLUSIONS: [68Ga]Ga-tilmanocept PET/CT identified SLNs in all patients, mainly in the lateral neck. The SLNs were successfully surgically detected and resected using ICG-[99mTc]Tc-nanocolloid. This technique has the potential to improve neck staging, enabling more personalized treatment of thyroid cancer according to the lymph node status.
BACKGROUND: 2021-002470-42 (EudraCT).
摘要：
目的：前哨淋巴结（SLN）活检很少用于甲状腺癌分期。这是由于与常规Tc-99m标记的示踪剂相关的挑战，通常在注射部位产生大的热点，潜在隐藏附近的SLN(透亮效应)。这项研究的目的是证明使用新的PET示踪剂[68Ga]Ga-tilmanocept进行SLN可视化的可行性和有效性。
方法：甲状腺癌患者接受超声引导瘤周注射[68Ga]Ga-tilmanocept和ICG-[99mTc]Tc-纳米胶体。[68Ga]Ga-tilmanoceptPET/CT扫描在注射后15分钟和60分钟进行，以可视化SLN。SLN活检使用ICG-[99mTc]TC-纳米胶体进行术中鉴定。切除相应的淋巴结水平作为参考。
结果：包括7例分化型甲状腺癌（DTC）和3例甲状腺髓样癌（MTC）患者，其中6例为临床淋巴结阴性。在[68Ga]Ga-tilmanoceptPET/CT上检测到并切除的SLN的中位数为3（范围1-4）和3（范围1-5），分别。在中央室的PET/CT上发现了8个SLN，在侧室中发现了19个。SLN程序在除一名患者外的所有患者中检测到（微）转移。经病理评估的27例SLN中有17例呈阳性，8负，2个不含淋巴结组织，这导致6例临床淋巴结阴性患者中的5例分期上升。
结论：[68Ga]Ga-tilmanoceptPET/CT确定所有患者的SLN，主要在侧颈。使用ICG-[99mTc]Tc-纳米胶体成功地手术检测和切除了SLN。这种技术有可能改善颈部分期，能够根据淋巴结状态对甲状腺癌进行更个性化的治疗。
背景：2021-002470-42（EudraCT）。
方法：甲状腺癌患者接受超声引导瘤周注射[68Ga]Ga-tilmanocept和ICG-[99mTc]Tc-纳米胶体。[68Ga]Ga-tilmanoceptPET/CT扫描在注射后15分钟和60分钟进行，以可视化SLN。SLN活检使用ICG-[99mTc]TC-纳米胶体进行术中鉴定。切除相应的淋巴结水平作为参考。
结果：包括7例分化型甲状腺癌（DTC）和3例甲状腺髓样癌（MTC）患者，其中6例为临床淋巴结阴性。在[68Ga]Ga-tilmanoceptPET/CT上检测到并切除的SLN的中位数为3（范围1-4）和3（范围1-5），分别。在中央室的PET/CT上发现了8个SLN，在侧室中发现了19个。SLN程序在除一名患者外的所有患者中检测到（微）转移。经病理评估的27例SLN中有17例呈阳性，8负，2个不含淋巴结组织，这导致6例临床淋巴结阴性患者中的5例分期上升。
结论：[68Ga]Ga-tilmanoceptPET/CT确定所有患者的SLN，主要在侧颈。使用ICG-[99mTc]Tc-纳米胶体成功地手术检测和切除了SLN。这种技术有可能改善颈部分期，能够根据淋巴结状态对甲状腺癌进行更个性化的治疗。
背景：2021-002470-42（EudraCT）。
