Intraoperative detection of somatostatin-receptor-positive neuroendocrine tumours using indium-111-labelled DTPA-D-Phe1-octreotide.
After injection of 111In-labelled DTPA-D-Phe1-octreotide, intraoperative tumour localisation was performed using a scintillation detector in 23 patients with neuroendocrine tumours. Count rates from suspect tumour lesions and adjacent normal tissue were expressed as a ratio before (Rin situ) and after (Rex vivo) excision. 111In activity concentration ratios of tumour tissue to blood (T/B) were determined in a gamma counter. In patients with midgut carcinoids, (all scintigraphy positive), false Rin situ recordings were found in 4/29 macroscopically identified tumours. T/B ratios were all high (27-650). In patients with medullary thyroid carcinomas (eight out of ten scintigraphy positive), misleading Rin situ results were found in 4/37 macroscopically identified tumours. T/B ratios were lower (3-39) than those seen in midgut carcinoids. Two out of four patients with endocrine pancreatic tumours had positive scintigraphy, reliable intraoperative measurements and very high T/B ratios (910-1500). One patient with a gastric carcinoid had correct measurements in situ and ex vivo with high T/B ratios (71-210). In situ measurements added little information to preoperative scintigraphy and surgical findings using the present detection system. Rex vivo measurements were more reliable. The very high T/B ratios seen in midgut carcinoids and some endocrine pancreatic tumours would be favourable for future radiation therapy via somatostatin receptors.
Wangberg
B
B
Department of Surgery, Sahlgrenska Hospital, Gothenburg, Sweden.
Forssell-Aronsson
E
E
Tisell
L E
LE
Nilsson
O
O
Fjalling
M
M
Ahlman
H
H
D002276:Carcinoid Tumor / Q000000981:diagnostic imaging / Q000601:surgery / Q000648:ultrastructure; D005260:Female; D006801:Humans; D007205:Indium Radioisotopes; D007430:Intraoperative Care; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging* / Q000601:surgery / Q000648:ultrastructure; D015282:Octreotide / Q000031:analogs & derivatives*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery / Q000648:ultrastructure; D004369:Pentetic Acid / Q000031:analogs & derivatives*; D011877:Radionuclide Imaging; D017481:Receptors, Somatostatin / Q000032:analysis*; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery / Q000648:ultrastructure; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery / Q000648:ultrastructure; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery / Q000648:ultrastructure
D007205:Indium Radioisotopes; D017481:Receptors, Somatostatin; C071632:SDZ 215-811; D004369:Pentetic Acid; D015282:Octreotide