Dominguez J M, Wolff B G, Nelson H, Forstrom L A, Mullan B P
Division of Colon and Rectal Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
Dis Colon Rectum. 1996 May;39(5):514-9. doi: 10.1007/BF02058703.
In a blinded fashion, radiolabeled B72.3 was investigated in operative cases of recurrent colorectal cancer to determine if diagnostic accuracy would be improved to ultimately maximize curability and minimize interventional morbidities.
Study patients underwent conventional evaluation including history, physical examination, abdominal/pelvic computed tomographic scan (CT), colon examination, and carcinoembryonic antigen (CEA) determination, with select magnetic resonance imaging and ultrasonographic imaging as indicated. Murine monoclonal antibody B72.3 was labeled with indium-111 (111In-CYT-103 provided by Cytogen) and scans obtained at 48 hours and, selectively, at 72 and 96 hours. Unlike previous studies, the operating surgeon was blinded to 111In-CYT-103 abdominal scan results until surgical exploration was complete.
Of 15 study patients (10 male; 5 female), average age was 57 years, and average CEA was 10 ng/ml (with eight elevated CEA levels). A single patient did not undergo surgery because of presence of pulmonary metastases identified on CT scan but not identified on a 111In-CYT-103 scan. Laparotomies included resection and intraoperative radiation (10), resection alone (1), and biopsy only (3). CT and 111In-CYT-103 scans were compared with operative findings. CT scans had an accuracy and positive predictive value of 47 and 100 percent, respectively, whereas those of 111In-CYT-103 scan were 60 and 82 percent, respectively. Contribution of the scan to diagnosis and management was graded by the surgeon as no effect (67 percent), beneficial effect (13 percent), or negative effect (20 percent).
111In-CYT-103 was more accurate compared with CT scan, but when value of the scan was examined with respect to its potential contribution to patient management, it was beneficial in only 13 percent of patients. Further refinements may enhance the value of antibody imaging techniques.
以盲法对复发性结直肠癌手术病例进行放射性标记的B72.3研究，以确定诊断准确性是否会提高，从而最终实现治愈率最大化并使介入性发病率最小化。
研究患者接受常规评估，包括病史、体格检查、腹部/盆腔计算机断层扫描（CT）、结肠检查和癌胚抗原（CEA）测定，并根据需要进行选择性磁共振成像和超声成像。鼠单克隆抗体B72.3用铟-111（由Cytogen提供的111In-CYT-103）标记，并在48小时以及选择性地在72和96小时进行扫描。与以往研究不同，手术外科医生在手术探查完成之前对111In-CYT-103腹部扫描结果不知情。
15例研究患者（10例男性；5例女性），平均年龄57岁，平均CEA为10 ng/ml（8例CEA水平升高）。1例患者因CT扫描发现但111In-CYT-103扫描未发现肺转移而未接受手术。剖腹手术包括切除及术中放疗（10例）、单纯切除（1例）和仅活检（3例）。将CT和111In-CYT-103扫描结果与手术发现进行比较。CT扫描的准确率和阳性预测值分别为47%和100%，而111In-CYT-103扫描的准确率和阳性预测值分别为60%和82%。外科医生将扫描对诊断和治疗的贡献评为无影响（67%）、有益影响（13%）或负面影响（20%）。
与CT扫描相比，111In-CYT-103更准确，但就其对患者治疗的潜在贡献评估扫描价值时，仅13%的患者从中受益。进一步改进可能会提高抗体成像技术的价值。
