Antibody guided lymphangiography in the staging of cervical cancer

Abstract

Summary Iodine-123-labelled tumour associated monoclonal antibody HMFG2 was administered intralymphatically at a time that cannulation of pedal lymphatic vessels was performed for standard lymphangiography in 6 patients with cervical cancer. Gamma camera images were taken at 2 h and 24 h after injection of antibody and at a similar time that X-ray lymphangiography was performed.Five out of the 6 standard lymphangiograms were reported as normal whilst one showed definite evidence of metastasis. Antibody guided analysis of the abnormal lymphangiogram confirmed the presence of abnormality. Also, marked non-specific uptake of antibody was seen on all lymphangiograms. It is concluded that, in order for monoclonal antibody guided lymphangiography to become a useful adjunct to standard lymphangiography, further improvements are needed to reduce non-specific uptake by normal lymphatics.

The detection of axillary lymph node metastases from breast cancer by radiolabelled monoclonal antibodies: a prospective study

“…Thus, the presence of reactive lymph nodes in the axilla, on the side of breast cancer, can lead to the uptake of radiolabelled antibody leading to false positive scintigraphic images, while the nonspecific uptake of radioactive material in the normal contralateral axilla could also lead to false negative interpretation of scintigraphic images. This phenomenon has also been described by other investigators (Epenetos, 1985;Nelp et al, 1987). It is likely that this may be due, in part, to binding through the Fc portion of the mouse immunoglobulin.…”

“…The use of radiolabelled antibodies for the detection of lymph node metastases is therefore an attractive concept which, if sufficiently sensitive and specific, may replace surgical axillary dissection. However, despite recent reports on immunoscintigraphy (Epenetos, 1985;Thompson et al, 1984), there are few prospective studies of immunoscintigraphy for the detection of axillary lymph node metastases and to relate findings from the scintigraphy with histology of the lymph nodes.…”

“…However, there were cases when immunoscintigraphy using radiolabelled antibody (IgM or IgG) detected axillary lymph node metastases not suspected by clinical examination. Thus it appears that while immunoscintigraphy may be a useful adjunct to preoperative clinical assessment and is simple and safe, a major improvement in its accuracy is needed before it can replace axillary dissection and histological examination in the accurate staging of axilla in breast cancer.The detection of overt tumour deposits by means of gammacamera imaging and radiolabelled monoclonal antibodies to tumour-associated antigens (immunoscintigraphy) has met with encouraging results (Armitage et al, 1984;Epenetos, 1985;Leyden et al, 1986;Mach et al, 1981;Rainsbury, 1984;Smedley et al, 1983;William et al, 1984). However, most of these studies have been performed on patients with well documented and widespread disease; few being prospective studies of the value of monoclonal immunoscintigraphy in the initial staging of patients with malignant disease.…”

“…The detection of overt tumour deposits by means of gammacamera imaging and radiolabelled monoclonal antibodies to tumour-associated antigens (immunoscintigraphy) has met with encouraging results (Armitage et al, 1984;Epenetos, 1985;Leyden et al, 1986;Mach et al, 1981;Rainsbury, 1984;Smedley et al, 1983;William et al, 1984). However, most of these studies have been performed on patients with well documented and widespread disease; few being prospective studies of the value of monoclonal immunoscintigraphy in the initial staging of patients with malignant disease.…”

Placental-type alkaline phosphatase in cervical neoplasia

“…We have attempted immunocytology on cervical smears using both H317 and H17-E2 in an indirect immunoperoxidase staining technique; however, no clear differences were noted between normal or abnormal cervix. The high levels of cervical tissue PLAP and PLAP-like AP activities suggest a potential as targets for radioimmunolocalisation of invasive and metastatic disease, as has been performed successfully in ovarian and testicular cancer (Epenetos et al, 1985b;Critchley et al, 1986), or for determining the extent of lymphatic spread by lymphangiography as has been attempted in cervical cancer using the HMFG2 mAb (Epenetos, 1985).…”