Radio-guided Surgery with the Use of [99mTc-EDDA/HYNIC]octreotate in Intra-operative Detection of Neuroendocrine Tumours of the Gastrointestinal Tract

Overview

Journal Eur J Nucl Med Mol Imaging

Specialties Biophysics
Nuclear Medicine
Radiology

Date 2007 Jul 27

PMID 17653543

Citations 10

Authors

A Hubalewska-Dydejczyk

J Kulig

P Szybinski

R Mikolajczak

D Pach

A Sowa-Staszczak

K Fross-Baron

B Huszno

Affiliations

Soon will be listed here.

Abstract

Purpose: 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.

Methods: 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).

Results: 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).

Conclusion: [(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.

Citing Articles

Emerging Treatment Options for Neuroendocrine Neoplasms of Unknown Primary Origin: Current Evidence and Future Perspectives.

Corti F, Rossi R, Cafaro P, Passarella G, Turla A, Pusceddu S Cancers (Basel). 2024; 16(11).

PMID: 38893145 PMC: 11171242. DOI: 10.3390/cancers16112025.

Surgical radioguidance with beta-emitting radionuclides; challenges and possibilities: A position paper by the EANM.

Fragoso Costa P, Shi K, Holm S, Vidal-Sicart S, Kracmerova T, Tosi G Eur J Nucl Med Mol Imaging. 2024; 51(10):2903-2921.

PMID: 38189911 PMC: 11300492. DOI: 10.1007/s00259-023-06560-2.

Radioguided Surgery for Gastroenteropancreatic Neuroendocrine Tumours: a Systematic Literature Review.

Cockburn K, Toumi Z, Mackie A, Julyan P J Gastrointest Surg. 2021; 25(12):3244-3257.

PMID: 34506015 PMC: 8654712. DOI: 10.1007/s11605-021-05115-w.

Surgery and Perioperative Management in Small Intestinal Neuroendocrine Tumors.

Deguelte S, Perrier M, Hammoutene C, Cadiot G, Kianmanesh R J Clin Med. 2020; 9(7).

PMID: 32708330 PMC: 7408509. DOI: 10.3390/jcm9072319.

Cholecystokinin-2 Receptor Targeting with Novel C-terminally Stabilized HYNIC-Minigastrin Analogs Radiolabeled with Technetium-99m.

Klingler M, Rangger C, Summer D, Kaeopookum P, Decristoforo C, von Guggenberg E Pharmaceuticals (Basel). 2019; 12(1).

PMID: 30650563 PMC: 6469167. DOI: 10.3390/ph12010013.

References

Decristoforo C, Mather S, Cholewinski W, Donnemiller E, Riccabona G, Moncayo R . 99mTc-EDDA/HYNIC-TOC: a new 99mTc-labelled radiopharmaceutical for imaging somatostatin receptor-positive tumours; first clinical results and intra-patient comparison with 111In-labelled octreotide derivatives. Eur J Nucl Med. 2000; 27(9):1318-25. DOI: 10.1007/s002590000289. View

Caudle A, Brier S, Calvo B, Kim H, Meyers M, Ollila D . Experienced radio-guided surgery teams can successfully perform minimally invasive radio-guided parathyroidectomy without intraoperative parathyroid hormone assays. Am Surg. 2006; 72(9):785-9. View

Guillermet-Guibert J, Lahlou H, Pyronnet S, Bousquet C, Susini C . Endocrine tumours of the gastrointestinal tract. Somatostatin receptors as tools for diagnosis and therapy: molecular aspects. Best Pract Res Clin Gastroenterol. 2005; 19(4):535-51. DOI: 10.1016/j.bpg.2005.03.007. View

Waddington W, Kettle A, Heddle R, Coakley A . Intraoperative localization of recurrent medullary carcinoma of the thyroid using indium-111 pentetreotide and a nuclear surgical probe. Eur J Nucl Med. 1994; 21(4):363-4. DOI: 10.1007/BF00947974. View

Krenning E, Kwekkeboom D, Bakker W, Breeman W, Kooij P, Oei H . Somatostatin receptor scintigraphy with [111In-DTPA-D-Phe1]- and [123I-Tyr3]-octreotide: the Rotterdam experience with more than 1000 patients. Eur J Nucl Med. 1993; 20(8):716-31. DOI: 10.1007/BF00181765. View

Ohrvall U, Westlin J, Kjellberg F, Nilsson S, Juhlin C, Rastad J . A gamma detector probe with ex vivo detection of carcinoid tumors superior to intraoperative palpation. Cancer. 1997; 80(12 Suppl):2495-500. DOI: 10.1002/(sici)1097-0142(19971215)80:12+<2495::aid-cncr22>3.3.co;2-b. View

Ellison , Schirmer , OLSEN , Pozderac , Hinkle , Hill . Localization of Neuroendocrine Tumors Using Somatostatin Receptor Imaging With Indium-111-Pentetreotide (OctreoScan). Cancer Control. 1997; 4(1):35-39. View

Storch D, Behe M, Walter M, Chen J, Powell P, Mikolajczak R . Evaluation of [99mTc/EDDA/HYNIC0]octreotide derivatives compared with [111In-DOTA0,Tyr3, Thr8]octreotide and [111In-DTPA0]octreotide: does tumor or pancreas uptake correlate with the rate of internalization?. J Nucl Med. 2005; 46(9):1561-9. View

Pitre S, Menard L, Ricard M, Solal M, Garbay J, Charon Y . A hand-held imaging probe for radio-guided surgery: physical performance and preliminary clinical experience. Eur J Nucl Med Mol Imaging. 2003; 30(3):339-43. DOI: 10.1007/s00259-002-1064-2. View

10.

Norton J, Sigel B, Baker A, Ettinghausen S, Shawker T, KRUDY A . Localization of an occult insulinoma by intraoperative ultrasonography. Surgery. 1985; 97(3):381-4. View

11.

Banzo J, Vidal-Sicat S, Prats E, Galofre G, Razola P, Mane S . In-111 DTPA octreotide scintigraphy and intraoperative gamma probe detection in the diagnosis and treatment of residual lymph node metastases of a rectal carcinoid tumor. Clin Nucl Med. 2005; 30(5):308-11. DOI: 10.1097/01.rlu.0000159525.31001.cc. View

12.

Benjegard S, Forssell-Aronsson E, Wangberg B, Skanberg J, Nilsson O, Ahlman H . Intraoperative tumour detection using 111In-DTPA-D-Phe1-octreotide and a scintillation detector. Eur J Nucl Med. 2001; 28(10):1456-62. DOI: 10.1007/s002590100600. View

13.

Kitagawa Y, Kitajima M . Diagnostic validity of radio-guided sentinel node mapping for gastric cancer: a review of current status and future direction. Surg Technol Int. 2006; 15:32-6. View

14.

Kowalski J, Henze M, Schuhmacher J, Macke H, Hofmann M, Haberkorn U . Evaluation of positron emission tomography imaging using [68Ga]-DOTA-D Phe(1)-Tyr(3)-Octreotide in comparison to [111In]-DTPAOC SPECT. First results in patients with neuroendocrine tumors. Mol Imaging Biol. 2003; 5(1):42-8. DOI: 10.1016/s1536-1632(03)00038-6. View

15.

Chiti A, Briganti V, Fanti S, Monetti N, Masi R, Bombardieri E . Results and potential of somatostatin receptor imaging in gastroenteropancreatic tract tumours. Q J Nucl Med. 2000; 44(1):42-9. View

16.

Brown K, Kristopaitis T, Yong S, Chejfec G, Pickleman J . Cystic glucagonoma: A rare variant of an uncommon neuroendocrine pancreas tumor. J Gastrointest Surg. 1999; 2(6):533-6. DOI: 10.1016/s1091-255x(98)80053-x. View

17.

Adams S, Baum R, Hertel A, Wenisch H, Herrmann G, Encke A . Intraoperative gamma probe detection of neuroendocrine tumors. J Nucl Med. 1998; 39(7):1155-60. View

18.

Ramage J, Davies A, Ardill J, Bax N, Caplin M, Grossman A . Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours. Gut. 2005; 54 Suppl 4:iv1-16. PMC: 1867801. DOI: 10.1136/gut.2004.053314. View

19.

Gabriel M, Decristoforo C, Donnemiller E, Ulmer H, Watfah Rychlinski C, Mather S . An intrapatient comparison of 99mTc-EDDA/HYNIC-TOC with 111In-DTPA-octreotide for diagnosis of somatostatin receptor-expressing tumors. J Nucl Med. 2003; 44(5):708-16. View

20.

Bertherat J, Tenenbaum F, Perlemoine K, Videau C, Alberini J, Richard B . Somatostatin receptors 2 and 5 are the major somatostatin receptors in insulinomas: an in vivo and in vitro study. J Clin Endocrinol Metab. 2003; 88(11):5353-60. DOI: 10.1210/jc.2002-021895. View