Quintana J C, Blend M J
Department of Radiology, College of Medicine, University of Illinois, Chicago, USA.
Clin Nucl Med. 2000 Jan;25(1):33-40. doi: 10.1097/00003072-200001000-00008.
Whole-body, regional planar, and SPECT imaging using the In-111-labeled monoclonal antibody capromab pendetide (In-111 MAb; ProstaScint) has been shown to increase the detection of early disease spread in patients with prostate cancer. However, recognition of metastatic tumor sites can be difficult, especially if the involved nodes are near blood vessels. We have developed an alternate approach to the identification of metastatic sites that is based on a single simultaneous In-111 MAb and Tc-99m RBC SPECT acquisition of the pelvis and abdomen on day 5 after injection. We have also developed software that dynamically subtracts the Tc-99m RBC data set (vascular component) from the In-111 MAb data set (prostate and lymph node component), which allows for easier identification of metastatic sites.
We evaluated the effectiveness of ProstaScint for staging 145 patients with prostate cancer, 19 newly diagnosed and 126 with recurrence, using these two modifications.
With clinical follow-up in 13 of 19 (68%) patients with primary disease, 10 of 13 (78%) had organ-confined disease. With follow-up in 64 of 126 (51%) patients with possible recurrent disease, 49 of 64 (77%) were found to have prostatic fossa activity only. Disease stage was deemed more advanced in 3 of 13 (22%) patients with primary cancer and in 13 of 64 (20%) of those with recurrent disease based on ProstaScint findings when all other imaging tests were inconclusive. Six patients with recurrent disease had negative results of their scans. In the 16 patients with more advanced disease, 3 of 59 lesions (5%) were documented as false positive, and there were no reported cases of false-negative findings.
Using both the dual-isotope procedure and the subtraction analysis software with the ProstaScint examination provides additional information for staging primary and possibly recurrent prostate cancer compared with standard imaging techniques.
已证实，使用铟 - 111标记的单克隆抗体卡普单抗（In - 111 MAb；ProstaScint）进行全身、局部平面和SPECT成像，可提高前列腺癌患者早期疾病扩散的检测率。然而，转移瘤部位的识别可能存在困难，尤其是当受累淋巴结靠近血管时。我们开发了一种识别转移部位的替代方法，该方法基于在注射后第5天对骨盆和腹部同时进行单同位素In - 111 MAb和锝 - 99m红细胞（Tc - 99m RBC）SPECT采集。我们还开发了软件，可从In - 111 MAb数据集（前列腺和淋巴结成分）中动态减去Tc - 99m RBC数据集（血管成分），从而更易于识别转移部位。
我们使用这两种改进方法评估了ProstaScint对145例前列腺癌患者（19例新诊断患者和126例复发患者）进行分期的有效性。
在19例原发性疾病患者中的13例（68%）进行临床随访后，13例中的10例（78%）患有器官局限性疾病。在126例可能复发疾病患者中的64例（51%）进行随访后，64例中的49例（77%）仅发现前列腺窝有活性。当所有其他影像学检查结果不明确时，根据ProstaScint检查结果，13例原发性癌症患者中的3例（22%）和64例复发疾病患者中的13例（20%）的疾病分期被认为更 advanced。6例复发疾病患者的扫描结果为阴性。在16例疾病更 advanced的患者中，59个病变中的3个（5%）被记录为假阳性，且无假阴性结果报告。
与标准成像技术相比，在ProstaScint检查中同时使用双同位素程序和减法分析软件可为原发性和可能复发的前列腺癌分期提供更多信息。
