Abstract
Rationale: Lymphoscintigraphy plays a vital role in sentinel lymph node (SLN) identification in oncologic breast surgery. The effectiveness of SLN localization and patient pain between filtered 99mTc labeled-Sulfur Colloid (Tc-SC) and 99mTc labeled-Tilmanocept (Tc-T) were compared. Methods: A retrospective review of patients undergoing lymphoscintigraphy for breast cancer using Tc-SC (6/1/2010-12/31/2011) or Tc-T from (6/1/2013-1/31/2014) was performed. SLN appearance time and uptake, SLN pathology, proportion of positive SLNs removed, and comparative pain scores were compared for each radiopharmaceutical using chi-squared, fisher’s exact, and unequal variance t-tests, as appropriate. Results: A total of 76 patients, with 86 evaluated axillae, underwent lymphoscintigraphy: 29 Tc-SC and 47 Tc-T. Mean SLN appearance time was 11.0 minutes for Tc-SC and 19.3 minutes for Tc-T, P = 0.003. There was no difference in the mean transit uptake percentage: 2.2% Tc-SC and 1.9% Tc-T, P = 0.55. Tc-T identified a greater proportion of intraoperative blue nodes than Tc-SC, P = 0.03. There was no significant difference between Tc-SC and Tc-T in the number of SLNs removed, number of patients with positive SLNs, or comparative pain score. Conclusion: Filtered 99mTc labeled-Sulfur Colloid use in lymphoscintigraphy is an acceptable alternative to 99mTc labeled-Tilmanocept for SLN detection in breast cancer, based on filtered 99mTc labeled-Sulfur Colloid’s similar intraoperative SLN identification and comparative pain scores.