Hubalewska-Dydejczyk A, Kulig J, Szybinski P, Mikolajczak R, Pach D, Sowa-Staszczak A, Fröss-Baron K, Huszno B
Nuclear Medicine Unit of the Department of Endocrinology, Medical College at Jagiellonian University, 31-501 Cracow, Poland.
Eur J Nucl Med Mol Imaging. 2007 Oct;34(10):1545-55. doi: 10.1007/s00259-007-0476-4. Epub 2007 Jul 25.
Radio-guided surgery (RGS) is an intra-operative localising technique which enables identification of tissue "marked" by a specific radiotracer injected before surgery. It is mainly used for sentinel node mapping and for detection of parathyroid adenomas and other tumours, including neuroendocrine tumours of the gastrointestinal tract (GEP-NET). The aim of this study was to determine whether intra-operative radio-detection with the use of [(99m)Tc-EDDA/HYNIC]octreotate, a new somatostatin analogue, is able to reveal an unknown primary and secondary sites, thereby improving surgical treatment and the final outcome of GEP-NET.
The study group included nine patients with suspected GEP-NET (four carcinoids, five pancreatic NET) localised with somatostatin receptor scintigraphy (with [(99m)Tc-EDDA/HYNIC]octreotate), who had negative results on other pre-operative imaging tests. At surgery, suspected tumours were measured in situ and ex vivo and precise exploration of the abdominal cavity was performed with the intra-operative scintillation detector (Navigator).
Intra-operative gamma counting localised three carcinoids. In one patient SRS was false positive (owing to inflammatory infiltration). Compared with SRS, RGS revealed additional lymph node metastases in one case. RGS resulted in successful localisation of all pancreatic NET (the smallest lesion was 8 mm in diameter).
[(99m)Tc-EDDA/HYNIC]octreotate SRS followed by RGS is a promising technique to improve the rate of detection and efficacy of treatment of GEP-NET, especially in the presence of occult endocrine tumours. The imaging properties of [(99m)Tc-EDDA/HYNIC]octreotate and the 1-day imaging protocol offer opportunities for more widespread application of this tracer followed by RGS in oncology.
放射性引导手术（RGS）是一种术中定位技术，可识别术前注射的特定放射性示踪剂“标记”的组织。它主要用于前哨淋巴结定位以及甲状旁腺腺瘤和其他肿瘤的检测，包括胃肠道神经内分泌肿瘤（GEP-NET）。本研究的目的是确定使用新型生长抑素类似物[（99m）Tc-EDDA/HYNIC]奥曲肽进行术中放射性检测是否能够揭示未知的原发和继发部位，从而改善GEP-NET的手术治疗和最终结果。
研究组包括9例疑似GEP-NET患者（4例类癌，5例胰腺神经内分泌肿瘤），通过生长抑素受体闪烁显像（使用[（99m）Tc-EDDA/HYNIC]奥曲肽）定位，术前其他影像学检查结果为阴性。手术中，对疑似肿瘤进行原位和离体测量，并使用术中闪烁探测器（Navigator）对腹腔进行精确探查。
术中γ计数定位了3例类癌。1例患者的生长抑素受体闪烁显像出现假阳性（由于炎症浸润）。与生长抑素受体闪烁显像相比，放射性引导手术在1例病例中发现了额外的淋巴结转移。放射性引导手术成功定位了所有胰腺神经内分泌肿瘤（最小病变直径为8毫米）。
[（99m）Tc-EDDA/HYNIC]奥曲肽生长抑素受体闪烁显像后进行放射性引导手术是一种有前景的技术，可提高GEP-NET的检测率和治疗效果，尤其是在存在隐匿性内分泌肿瘤的情况下。[（99m）Tc-EDDA/HYNIC]奥曲肽的成像特性和1天成像方案为该示踪剂随后在肿瘤学中更广泛地应用于放射性引导手术提供了机会。
