Name of the Procedure:

Common Name(s): Tc-99m Tilmanocept Scintigraphy
Technical/Medical Term(s): Technetium Tc-99m Tilmanocept Imaging, Lymphoscintigraphy

Summary

Tc-99m Tilmanocept is a diagnostic imaging procedure used to evaluate lymphatic function. A small amount of Technetium Tc-99m, a radioactive tracer, is injected and visualized using a special camera to help identify lymph nodes and determine the presence of certain diseases.

Purpose

Tc-99m Tilmanocept imaging is primarily used to:

• Identify sentinel lymph nodes in cancer patients, particularly those with breast cancer or melanoma.
• Guide surgical planning by mapping lymphatic drainage.
• Detect abnormal lymphatic function or blockages.

Indications

• Patients with diagnosed breast cancer or melanoma.
• Determination of sentinel lymph nodes for surgical removal or biopsy.
• Evaluation of unexplained lymphatic swelling or blockages.

Preparation

• Patients may be advised to fast for a few hours before the procedure.
• Patients should inform their doctor of all medications and allergies.
• Pre-procedure assessments may include a physical exam and blood tests.

Procedure Description

1. A small syringe is used to inject Tc-99m Tilmanocept near the tumor or area of interest.
2. The patient waits for the tracer to travel to the lymph nodes, typically taking 15-60 minutes.
3. During this time, a gamma camera captures images of the tracer’s path and the nodes it gathers in.
4. The images are analyzed to identify sentinel lymph nodes.
   • The procedure usually does not require anesthesia.

Duration

The entire procedure typically takes about 1-2 hours, including waiting time for the tracer to distribute.

Setting

The procedure is performed in a hospital’s nuclear medicine department or an outpatient imaging center.

Personnel

• A nuclear medicine technologist administers the tracer and captures images.
• A radiologist interprets the images.
• Occasionally, a surgeon may be involved to coordinate the findings with surgical planning.

Risks and Complications

• Rare allergic reactions to the tracer.
• Slight discomfort or pain at the injection site.
• Minimal radiation exposure, considered very low risk.

Benefits

• Provides accurate mapping of lymph nodes, aiding in the appropriate surgical approach.
• Non-invasive, with minimal discomfort.
• Can detect lymphatic abnormalities early to guide timely intervention.

Recovery

• There are generally no significant side effects, allowing immediate resumption of daily activities.
• Follow-up appointments may be scheduled based on imaging results.

Alternatives

• Sentinel lymph node biopsy without preoperative imaging can be more invasive.
• Other imaging modalities like MRI or CT scans, which might not offer the same precision for lymph node mapping.
• Ultrasound, which is less effective in mapping lymph flow.

Patient Experience

• Patients might experience slight discomfort during the injection.
• The procedure is generally painless and does not cause significant discomfort afterwards.
• Pain management is seldom required, and comfort measures are typically limited to addressing any mild post-injection soreness.