Intraoperative hand held gamma probe detection of a recurrent nonfunctional neuroendocrine tumor.
BACKGROUND
The advantage of intraoperative gamma probe detection with (111)In-DPTA-octreotide radiotracer has previously been demonstrated in functional neuroendocrine tumors. We report the only known case of a recurrent nonfunctional pancreatic neuroendocrine neoplasm localized intraoperatively using this radiotracer and a hand held gamma probe.


METHODS
A 51-year-old woman was found to have a recurrence 23 months after laparoscopic distal pancreatectomy, splenectomy and wedge resection of a liver metastasis for a non-functional neuroendocirne neoplasm of the pancreas. CT scan and (111)In-DPTA-octreotide scan displayed two lesions in the right lobe of the liver and a third area of increased isotope uptake adjacent to kidney and pancreas. A single liver lesion was seen on CT. There were concerns regarding the ability to localize the lesion in the upper abdomen. In order to facilitate identification the patient was injected with (111)In-DPTA-octreotide preoperatively and intraoperatively a gamma probe was used to identify two lymph node posterior to the pancreas, only one of which could be palpated.


CONCLUSIONS
In this case the technique of preoperative injection with octreotide radiotracer and intraoperative hand held gamma probe successfully localized a nonfunctional neuroendocrine tumor that CT scan and intraoperative exploration failed to identify.
Van Haren
Robert M
RM
College of Human Medicine, Michigan State University, Lansing, MI, USA.
Fitzgerald
Timothy L
TL
D018278:Carcinoma, Neuroendocrine / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D005260:Female; D005720:Gamma Rays; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D008207:Lymphatic Metastasis / Q000175:diagnosis / Q000000981:diagnostic imaging; D008875:Middle Aged; D015282:Octreotide / Q000031:analogs & derivatives; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D004369:Pentetic Acid / Q000031:analogs & derivatives; D011874:Radiometry / Q000295:instrumentation*; D012008:Recurrence; D012086:Reoperation; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
C071632:SDZ 215-811; D004369:Pentetic Acid; D015282:Octreotide