Schirmer W J, O'Dorisio T M, Schirmer T P, Mojzisik C M, Hinkle G H, Martin E W
Division of General Surgery, University Hospitals, Columbus, OH 43210.
Surgery. 1993 Oct;114(4):745-51; discussion 751-2.
This study evaluates a novel method of intraoperative localization of endocrine gastroenteropancreatic tumors with a hand-held gamma-detecting probe to detect in situ tumor binding of the radioiodinated somatostatin analog 125I-TYR(3)-octreotide.
Seven patients with biochemical and radiologic evidence of a specific endocrine tumor, one patient with biochemical evidence of gastrinoma but no tumor localized by conventional imaging techniques, and four patients with equivocal preoperative biochemical or radiologic study results but suspected of harboring a neuroendocrine tumor underwent abdominal exploration with intraoperative injection of 125I-TYR(3)-octreotide. 298 +/- 63 microCi. A hand-held gamma-detecting probe was used during operation to determine whether gross tumor accumulated the radiolabeled analog and occult tumor could be detected. Positive uptake was defined as tumor/background ratios exceeding 2:1.
The tumor in all seven patients with gross disease accumulated 125I-TYR(3)-octreotide. Occult tumor beyond that appreciated with preoperative imaging or by routine operative exploration was detected in a patient with carcinoid tumor. In the patient with the occult gastrinoma the probe detected the lesion within the duodenal bulb before duodenotomy and also predicted what proved histologically to be positive peripancreatic adenopathy. There was a single false-positive reading from the stomach in a patient with suspected carcinoid tumor in whom no tumor could be found grossly or histologically. A pancreatic mass that probed negative proved to be an adenocarcinoma of ductal origin.
Tumor-specific peptide-receptor binding can be detected in situ with 125J-TYR(3)-octreotide and a hand-held gamma-detecting probe. This technique may facilitate neuroendocrine tumor localization and operative cytoreduction.
本研究评估了一种术中定位内分泌胃肠胰腺肿瘤的新方法，该方法使用手持式γ探测仪检测放射性碘化生长抑素类似物125I-TYR(3)-奥曲肽的原位肿瘤结合情况。
7例有特定内分泌肿瘤生化及影像学证据的患者、1例有胃泌素瘤生化证据但传统成像技术未定位到肿瘤的患者以及4例术前生化或影像学研究结果不明确但怀疑患有神经内分泌肿瘤的患者接受了腹部探查，术中注射125I-TYR(3)-奥曲肽，剂量为298±63微居里。术中使用手持式γ探测仪确定大体肿瘤是否积聚放射性标记的类似物，并检测隐匿性肿瘤。阳性摄取定义为肿瘤/背景比值超过2:1。
所有7例有明显病变的患者的肿瘤均积聚了125I-TYR(3)-奥曲肽。在1例类癌患者中检测到术前成像或常规手术探查未发现的隐匿性肿瘤。在隐匿性胃泌素瘤患者中，探测仪在十二指肠切开术前检测到十二指肠球部的病变，并且还预测了经组织学证实为胰腺周围阳性腺病的情况。1例疑似类癌肿瘤患者的胃部出现了1例假阳性读数，该患者在大体或组织学上均未发现肿瘤。1个探测为阴性的胰腺肿块经证实为导管起源的腺癌。
使用125I-TYR(）-奥曲肽和手持式γ探测仪可原位检测肿瘤特异性肽受体结合情况。该技术可能有助于神经内分泌肿瘤的定位及手术细胞减灭。
