Czepczyński Rafał, Parisella Maria Gemma, Kosowicz Jerzy, Mikołajczak Renata, Ziemnicka Katarzyna, Gryczyńska Maria, Sowiński Jerzy, Signore Alberto
Department of Endocrinology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznań, Poland.
Eur J Nucl Med Mol Imaging. 2007 Oct;34(10):1635-45. doi: 10.1007/s00259-007-0479-1. Epub 2007 May 26.
Several new somatostatin analogues have been developed for the diagnosis and therapy of different tumours. Since somatostatin receptors are often over-expressed in medullary thyroid carcinoma (MTC), the aim of our study was to evaluate the utility of scintigraphy with the somatostatin analogue (99m)Tc-EDDA/HYNIC-TOC in MTC in comparison with other diagnostic techniques.
Forty-five patients with MTC, aged 14-83 years, were investigated. Scintigraphy using (99m)Tc-EDDA/HYNIC-TOC (Tektrotyd) was performed 2 and 4 h post injection of 740 MBq (20 mCi) of the tracer. Other imaging techniques were also applied and analysed in individual cases (ultrasonography, computed tomography, (99m)Tc(V)-DMSA, (131)I-MIBG, (99m)Tc-MDP, (111)In-DTPA-octreotide and (18)F-FDG-PET) and compared with (99m)Tc-EDDA/HYNIC-TOC.
In group 1 (eight patients before thyroidectomy), uptake of the tracer was found in the primary tumours. In group 2 (six patients with remission), a false positive result was found in one patient; in the remaining five patients, no pathological foci were visualised. In group 3 (31 patients with post-surgical hypercalcitoninaemia), scintigraphy was true positive in 23 patients (74.2%): uptake in the thyroid bed was found in five patients, in the lymph nodes in 18 and in bone metastases in four. Using (99m)Tc-EDDA/HYNIC-TOC scintigraphy, the overall sensitivity was 79.5%, specificity 83.3%, accuracy 80.0%, positive predictive value 96.9% and negative predictive value 38.5%.
(99m)Tc-EDDA/HYNIC-TOC is clinically useful for scintigraphy in the follow-up of patients with MTC. It can be used in clinical practice for preoperative evaluation, for localisation of local recurrence or distant metastases and particularly for therapy decision making.
已研发出几种新型生长抑素类似物用于不同肿瘤的诊断和治疗。由于生长抑素受体在甲状腺髓样癌（MTC）中常过度表达，我们研究的目的是评估生长抑素类似物（99m）Tc - EDDA/HYNIC - TOC闪烁扫描术在MTC中的应用价值，并与其他诊断技术进行比较。
对45例年龄在14至83岁之间的MTC患者进行了研究。在注射740 MBq（20 mCi）示踪剂后2小时和4小时进行（99m）Tc - EDDA/HYNIC - TOC（Tektrotyd）闪烁扫描。还对个别病例应用并分析了其他成像技术（超声、计算机断层扫描、（99m）Tc（V） - DMSA、（131）I - MIBG、（99m）Tc - MDP、（111）In - DTPA - 奥曲肽和（18）F - FDG - PET），并与（99m）Tc - EDDA/HYNIC - TOC进行比较。
第1组（8例甲状腺切除术前患者），在原发性肿瘤中发现了示踪剂摄取。第2组（6例缓解期患者），1例患者出现假阳性结果；其余5例患者未发现病理病灶。第3组（31例术后高降钙素血症患者），闪烁扫描术在23例患者中呈真阳性（74.2%）：5例患者在甲状腺床发现摄取，18例在淋巴结，4例在骨转移灶。使用（99m）Tc - EDDA/HYNIC - TOC闪烁扫描术，总体敏感性为79.5%，特异性为83.3%，准确性为80.0%，阳性预测值为96.9%，阴性预测值为38.5%。
（99m）Tc - EDDA/HYNIC - TOC在MTC患者随访的闪烁扫描术中具有临床应用价值。它可用于临床实践中的术前评估、局部复发或远处转移的定位，特别是用于治疗决策。
