Adams S, Baum R P, Hertel A, Wenisch H J, Staib-Sebler E, Herrmann G, Encke A, Hör G
Department of Nuclear Medicine, Johann Wolfgang Goethe University Medical Center, Frankfurt/Main, Germany.
J Nucl Med. 1998 Jul;39(7):1155-60.
Previous studies of the intraoperative use of a handheld gamma probe to localize metastases and primary tumors of colorectal cancer have shown improved assessment of tumor spread and changes in surgical management based on added information gained by radioimmunoguided surgery. We conducted a prospective study to determine whether intraoperative radiodetection is able to reveal microscopic and occult disease of neuroendocrine tumors [medullary thyroid carcinomas (MTCs), gastroenteropancreatic (GEP) tumors].
After the injection of 180 MBq [111In-diethylenetriaminepentaacetic acid (DTPA)-D-Phe1]pentetreotide and/or 500 MBq 99mTc-dimercaptosuccinic acid (DMSA) (both for double-nuclide scintigraphy), preoperative somatostatin receptor imaging (12 patients with GEP tumors) and double-nuclide scintigraphy (10 patients with relapsing MTCs were performed. The results were combined with the information obtained from conventional imaging modalities (CT and sonography). Intraoperative radiodetection was performed 24 hr after administration of [111In-DTPA-D-Phe1]pentetreotide or 4 hr after the injection of 99mTc-DMSA using a handheld gamma probe.
Intraoperative gamma counting localized 70 somatostatin receptor-positive lesions of GEP tumors, whereas preoperative receptor imaging visualized 74%, surgical palpation visualized 44% and radiological imaging modalities localized only 43%. In 10 patients with recurrent MTCs, the surgeon was successful in localizing and removing 30 tumor lesions using the gamma probe. Twenty-seven of 30 lesions demonstrated tumor involvement, whereas 3 lesions were false-positive (lymphadenitis). Double-nuclide scintigraphy revealed 67% (Octreoscan, 7 of 20; 99mTc-DMSA, 13 of 20), surgical palpation revealed 60% and conventional imaging methods (CT, sonography) revealed only 50% of all lesions detected intraoperatively by the handheld gamma probe. The smallest lesion identified by the handheld probe (not palpated by the surgeon) was a lymph node metastasis (5-mm diameter).
The preliminary data show that intraoperative handheld gamma probe detection of microscopic and occult endocrine tumors is feasible and more sensitive than external scintigraphy and conventional imaging.
先前关于术中使用手持式γ探测器定位结直肠癌转移灶和原发肿瘤的研究表明，基于放射免疫导向手术获得的额外信息，对肿瘤扩散的评估得到改善，手术管理也发生了变化。我们进行了一项前瞻性研究，以确定术中放射探测是否能够揭示神经内分泌肿瘤（甲状腺髓样癌（MTC）、胃肠胰（GEP）肿瘤）的微小和隐匿性疾病。
注射180MBq[111铟-二乙三胺五乙酸（DTPA）-D-苯丙氨酸1]喷替肽和/或500MBq 99m锝-二巯基丁二酸（DMSA）（均用于双核素闪烁显像）后，进行术前生长抑素受体显像（12例GEP肿瘤患者）和双核素闪烁显像（10例复发性MTC患者）。结果与从传统成像方式（CT和超声）获得的信息相结合。在给予[111铟-DTPA-D-苯丙氨酸1]喷替肽24小时后或注射99m锝-DMSA 4小时后，使用手持式γ探测器进行术中放射探测。
术中γ计数定位了70个GEP肿瘤的生长抑素受体阳性病变，而术前受体显像显示74%，手术触诊显示44%，放射成像方式仅定位43%。在10例复发性MTC患者中，外科医生使用γ探测器成功定位并切除了30个肿瘤病变。30个病变中有27个显示有肿瘤累及，而3个病变为假阳性（淋巴结炎）。双核素闪烁显像显示67%（奥曲肽扫描，20个中有7个；99m锝-DMSA，20个中有13个），手术触诊显示60%，传统成像方法（CT、超声）仅显示手持式γ探测器术中检测到的所有病变的50%。手持式探测器识别出的最小病变（外科医生未触诊到）是一个淋巴结转移灶（直径5毫米）。
初步数据表明，术中手持式γ探测器检测微小和隐匿性内分泌肿瘤是可行的，并且比外部闪烁显像和传统成像更敏感。
