title: Indium-111-labeled girentuximab immunoSPECT as a diagnostic tool in clear cell renal cell carcinoma.
abstract: BACKGROUND
  Improved and more frequent radiologic evaluation has resulted in increased identification of renal masses of unknown origin, which frequently pose a diagnostic dilemma for urologists.
  
  
  OBJECTIVE
  Carbonic anhydrase IX (CAIX) is an antigen ubiquitously expressed in clear cell renal cell carcinoma (ccRCC). The specific and high level of expression in ccRCC makes CAIX an excellent target for imaging ccRCC lesions. We present our experience with immuno-single-photon emission computed tomography (immunoSPECT) imaging with the indium-111 ((111)In)-labeled anti-CAIX antibody girentuximab in patients presenting with either a primary renal tumor or a history of ccRCC and lesions suspect for metastases during follow-up.
  
  
  METHODS
  Twenty-nine patients received 100-200 MBq (111)In-labeled girentuximab. Whole-body and single photon emission computed tomography (SPECT) images were acquired after 4-7 d.
  
  
  METHODS
  Injection with (111)In-girentuximab and image acquisition after 4-7 d.
  
  
  METHODS
  Accuracy of (111)In-girentuximab immunoSPECT.
  
  
  CONCLUSIONS
  Distinct uptake of (111)In-girentuximab was seen in 16 of 22 patients presenting with a renal mass. All renal masses proven to be ccRCC after resection (n=15) were detected with (111)In-girentuximab. Suspect lesions of six patients showed no uptake of (111)In-girentuximab. In these patients, ccRCC was not found, nor progression occurred. Seven patients with a history of ccRCC and possible metastatic lesions on follow-up computed tomography scans were imaged with (111)In-girentuximab. In four of these patients, the lesions showed preferential uptake of (111)In-girentuximab and local or systemic treatment was initiated. In three other cases, no (111)In-girentuximab targeting was seen. During follow-up of these three patients, one showed progression, for which systemic treatment was started. In the two other patients, no progression occurred, suggesting a benign nature.
  
  
  CONCLUSIONS
  (111)In-girentuximab immunoSPECT can be used to detect ccRCC lesions in patients with a primary renal mass and to clarify the nature of lesions suspect for metastases in patients with a history of ccRCC.
authors: Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. s.muselaers@uro.umcn.nl
authors: Constantijn H J
authors: CH
authors: Muselaers
authors: Otto C
authors: OC
authors: Boerman
authors: Egbert
authors: E
authors: Oosterwijk
authors: Johannes F
authors: JF
authors: Langenhuijsen
authors: Wim J G
authors: WJ
authors: Oyen
authors: Peter F A
authors: PF
authors: Mulders
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal; D000951:Antigens, Neoplasm / Q000276:immunology*; D014408:Biomarkers, Tumor / Q000276:immunology; D000071231:Carbonic Anhydrase IX; D002256:Carbonic Anhydrases / Q000276:immunology*; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000276:immunology; D005260:Female; D006801:Humans; D007205:Indium Radioisotopes; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D000911:Antibodies, Monoclonal; D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; C106533:G250 monoclonal antibody; D007205:Indium Radioisotopes; D019275:Radiopharmaceuticals; C089226:CA9 protein, human; D000071231:Carbonic Anhydrase IX; D002256:Carbonic Anhydrases