Tc-Tilmanocept Versus Tc-Sulfur Colloid in Lymphoscintigraphy: Sentinel Lymph Node Identification and Patient-Reported Pain.

Lymphoscintigraphy plays a vital role in sentinel lymph node (SLN) identification in oncologic breast surgery. The effectiveness of SLN localization and the degree of patient pain were compared between filtered Tc-sulfur colloid (Tc-SC) and Tc-tilmanocept. A retrospective review of patients undergoing lymphoscintigraphy for breast cancer using Tc-SC (June 1, 2010, to December 31, 2011) or Tc-tilmanocept (June 1, 2013, to January 31, 2014) was performed. SLN appearance time and uptake, SLN pathology, proportion of positive SLNs removed, and pain scores were compared for each radiopharmaceutical using the χ test, Fisher exact test, and unequal variance test, as appropriate. In total, 76 patients, with 86 evaluated axillae, underwent lymphoscintigraphy: 29 with Tc-SC and 47 with Tc-tilmanocept. The mean SLN appearance time was 11.0 min for Tc-SC and 19.3 min for Tc-tilmanocept ( = 0.003). There was no difference in the mean transit uptake percentage: 2.2% for Tc-SC and 1.9% for Tc-tilmanocept ( = 0.55). Tc-tilmanocept identified a greater proportion of intraoperative blue nodes than did Tc-SC ( = 0.03). There was no significant difference between Tc-SC and Tc-tilmanocept in the number of SLNs removed, number of patients with positive SLNs, or pain score. Tc-SC use in lymphoscintigraphy is an acceptable alternative to Tc-tilmanocept for SLN detection in breast cancer, on the basis of the similarity in intraoperative SLN identification and pain scores.