Sentinel node identification with [99mTc]-tilmanocept SPECT/CT: a pictorial essay of clinical applications

Introduction: The recently developed radiopharmaceutical for sentinel node depiction is the mannose derivate Tilmanocept (Lymphoseek®). [99mTc]-tilmanocept, as a receptor-binding molecular imaging agent, has been approved by the US Food and Drug Administration and European Medicines Agency in 2014 for lymphatic mapping and lymph-node localization in breast cancer, melanoma, clinically node-negative squamous cell carcinoma of the oral cavity, and other solid tumors. Methods: Selected patients were enrolled in a retrospective study on the use of [99mTc]-tilmanocept planar scintigraphy, and SPECT/CT in melanoma, oral and breast cancer. Results: In this pictorial review, we present, in a clinical series of nine patients, the most commonly observed SLN identification findings and the related benefits using planar scintigraphy and SPECT/CT [99mTc]-tilmanocept in melanoma, oral and breast cancer. Discussion: [99mTc]-tilmanocept SPECT/CT resulted in an excellent choice for preoperative lymphatic mapping and presented an optimal biodistribution with a rapid injection-site clearance and persistent SLN retention that could lead to improved accuracy of sentinel node identification in selected cases of melanoma, oral and breast cancer.