TY - JOUR
T1 - Indium-111-pentetreotide scanning versus conventional imaging techniques for the localization of gastrinoma
AU - Schirmer, William J.
AU - Melvin, W. Scott
AU - Rush, Robert M.
AU - O'Dorisio, Thomas M.
AU - Pozderac, Rodney V.
AU - Olsen, John O.
AU - Ellison, E. Christopher
N1 - Funding Information:
OPTIMAL MANAGEMENT OF patients with gastrinomas requires accurate tumor localization and staging. Various imaging methods have been evaluated including ultrasonography, computed axial tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasonography, selective arteriography, transhepatic portal venous sampling, and secretin angiography.l7 No single method or combination of methods has emerged as a gold standard for identifying the location of the primary tumor(s) and predicting the presence and extent of metastases. Most conventional imaging techniques can- Supported by the Clinical Research Center of The Ohio State University (National Institutes of Health, General Clinical Research Center, RR-34). Presented at the Sixteenth Annual Meeting of the American Association of Endocrine Surgeons, Philadelphia, Pa., April 23-25, 1995. Reprint requests: WilliamJ.S chirmer, MD, Department of Surgery, 410 W. 10th Ave., Columbus, OH 43210, Copyright 9 1995 by Mosby-Year Book, Inc. 0039-6060/95/$5.00 + 0 11/6/67527 not detect tumors less than 1 cm. Preoperative localization of the primary tumor increases the probability that the tumor will be found at laparotomy and thus increases the chance of cure. 1 Somatostatin receptor scintigraphy has emerged as a promising technique for imaging neuroendocrine tumors, sq7 A high concentration of high affinity somatostatin receptors, the basis for somatostatin radiore-ceptor imaging, is present in more than 90% of gastri-nomas. The first somatostatin-based radiopharmaceutical, 123I-TYR(3)-octreotide, was introduced in 1989 by Krenning et al. 8 from the Netherlands. It proved effective in identifying metastatic extraabdominal neuroendocrine tumors but, because of high hepatic clearance and secretion into the bowel, was of limited value for localizing small intraabdominal or intrahepatic tumors.ll, 12 lllin_pentetreotid e overcomes many of the pitfalls of 123I-TYR(3)-octreotide.l~ 13,14 llJin_pente - treotide is excreted primarily by the kidneys with minimal physiologic uptake within the liverJ ~ Background activity in the right upper quadrant is much more favor-
PY - 1995/12
Y1 - 1995/12
N2 - Background. The present study evaluates 111In-pentetreotide scanning as a method for detection of gastrinomas. Operative findings serve as the benchmark for comparison of the efficacy of 111In-pentetreotide versus conventional imaging studies. Methods. Twelve patients (seven female and five male; age, 37 to 80 years) with histologic confirmation of gastrinoma underwent thin section dynamic computed tomography (CT) scanning and 111In-pentetreotide scanning. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 111In-pentetreotide and CT scanning are compared on the basis of tumor size and location. Results. Thirty discrete foci of intrahepatic and extrahepatic tumors were detected at operation. CT scanning detected three of nine pancreaticoduodenal lesions, whereas eight of these nine extrahepatic primary tumors were imaged by 111In-pentetreotide scanning. No false-positive 111In-pentetreotide scans were noted. The sensitivity of CT scanning for detection of metastatic disease was 56% versus 94% for the 111In-pentetreotide scan. Successful CT imaging was highly dependent on tumor size. No tumor smaller than 1 cm was imaged by CT, whereas four of seven lesions greater than 1 cm were imaged by 111In-pentetreotide scintigraphy. The smallest gastrinoma imaged by 111In-pentetreotide scanning was a 4 mm duodenal tumor. Conclusions. 111In-pentetreotide scanning, was superior to CT scanning for localizing gastrinomas. Further studies are required to determine whether 111In-pentetreotide scans will complement or replace traditional imaging methods.
AB - Background. The present study evaluates 111In-pentetreotide scanning as a method for detection of gastrinomas. Operative findings serve as the benchmark for comparison of the efficacy of 111In-pentetreotide versus conventional imaging studies. Methods. Twelve patients (seven female and five male; age, 37 to 80 years) with histologic confirmation of gastrinoma underwent thin section dynamic computed tomography (CT) scanning and 111In-pentetreotide scanning. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 111In-pentetreotide and CT scanning are compared on the basis of tumor size and location. Results. Thirty discrete foci of intrahepatic and extrahepatic tumors were detected at operation. CT scanning detected three of nine pancreaticoduodenal lesions, whereas eight of these nine extrahepatic primary tumors were imaged by 111In-pentetreotide scanning. No false-positive 111In-pentetreotide scans were noted. The sensitivity of CT scanning for detection of metastatic disease was 56% versus 94% for the 111In-pentetreotide scan. Successful CT imaging was highly dependent on tumor size. No tumor smaller than 1 cm was imaged by CT, whereas four of seven lesions greater than 1 cm were imaged by 111In-pentetreotide scintigraphy. The smallest gastrinoma imaged by 111In-pentetreotide scanning was a 4 mm duodenal tumor. Conclusions. 111In-pentetreotide scanning, was superior to CT scanning for localizing gastrinomas. Further studies are required to determine whether 111In-pentetreotide scans will complement or replace traditional imaging methods.
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U2 - 10.1016/S0039-6060(05)80121-7
DO - 10.1016/S0039-6060(05)80121-7
M3 - Article
C2 - 7491530
AN - SCOPUS:0028841608
SN - 0039-6060
VL - 118
SP - 1105
EP - 1114
JO - Surgery
JF - Surgery
IS - 6
ER -