Radioisotope-guided surgery in patients with pheochromocytoma and recurrent medullary thyroid carcinoma

Abstract

BACKGROUND The objective of this study was to appraise the detection of metastases of medullary thyroid carcinoma (MTC) and pheochromocytoma using radioguided surgery (RGS) and to compare the results with external imaging modalities, surgical palpation, and histopathologic findings. METHODS Twenty‐five patients with recurrent MTC underwent preoperative scintigraphic imaging with 500 megabecquerels (MBq) of technetium 99m(V)‐dimercaptosuccinic acid [99mTc(V)‐DMSA] and 222 MBq of indium 111 (111In)‐pentetreotide. The radiopharmaceutical that showed the greatest preoperative tumor uptake was selected for intraoperative RGS. Surgery was performed 24 hours after the administration of 111In‐pentetreotide or 4 hours after the injection of 99mTc(V)‐DMSA. Furthermore, three male patients underwent surgery who suffered from recurrent pheochromocytoma (injection of 180 MBq iodine 123‐labeled metaiodobenzylguanidine [123I‐MIBG] 4–5 hours before surgery). RESULTS Overall, lesion detection sensitivities in patients with MTC for computed tomography, 111In‐pentetreotide, and 99mTc(V)‐DMSA were 32%, 34%, and 65%, respectively. Surgical palpation identified lymph node metastases of recurrent MTC with a sensitivity of 65%, whereas RGS localized 64 malignant lesions (sensitivity, 97%). Altogether, 71 lesions could be excised, 5 of which were adjudged false positive with respect to MTC metastases. Both surgical palpation and RGS localized all paravertebral subdiaphragmatic lesions (size ≥ 2 cm) of recurrent pheochromocytoma seen in the preoperative MIBG scan. CONCLUSIONS RGS was capable of localizing more and smaller metastases of MTC compared with conventional imaging modalities and surgical palpation. However, the relatively high radioligand accumulation in the kidneys (111In‐pentetreotide) and the dense hepatic and biliary signals using MIBG limited their use for intraoperative detection of tumors in the area of the adrenal gland. Cancer 2001;92:263–70. © 2001 American Cancer Society.

Preoperative ultrasound-guided carbon nanoparticles localization for metastatic lymph nodes in papillary thyroid carcinoma during reoperation

“…Therefore, to identify the metastatic lymph nodes during reoperation, many methods were reported to be used for localization, such as hook-needle, intraoperative ultrasound, radio-guided surgery, and dyes. [20–22] With respect to the dyes, the initial lymph tracer was methylene blue, which may cause local infection and it diffused so easily that the time of surgery was limited. [23] Afterward, charcoal tattooing was extensively used as lymph tracer for tumor operation, but it lacks the directivity for lymphatic system because of its varied particle size.…”

The diagnostic role of 68Ga-DOTATATE PET/CT in the detection of neuroendocrine tumours

“…The sensitivity of 131 I-MIBG (meta-iodobenzyl-guanidine) for the detection of MTC is 29-30% [25], and the sensitivity of SRS ranges from 25 to 50% [5,26].…”

Molecular Imaging of Neuroendocrine Tumors

“…In particular, lesions less than 1 cm are not effectively detected by SRS. 104 The sensitivity of SRS also correlates with hCT levels. 105 A study using [ 68 Ga] DOTATATE reported a per-patient sensitivity of 72%, compared to 78% for FDG.…”