Tomoscintigraphy for detecting gastrointestinal and medullary thyroid cancers: first clinical results using radiolabelled monoclonal antibodies against carcinoembryonic antigen.

Berche, C.; Mach, Jean‐Pierre; Lumbroso, J.; Langlais, Crystal S.; Aubry, Florent; Buchegger, Franz; Carrel, Stefan; Rougier, P; Parmentier, C; Tubiana, M

doi:10.1136/bmj.285.6353.1447

Cited by 148 publications

(29 citation statements)

References 8 publications

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“…Several studies have shown the capability of ISG performed with '"'I or "'In-labelled anti-CEA MAb to visualise MTC recurrences (Berche et al, 1982;Reiners et al, 1986;Edington et al, 1988;Manil et al, 1989;Zanin et al, 1990;O'Byrne et al, 1992;Vuillez et al, 1992). However, after injection of directly labelled MAb, image interpretation is sometimes difficult because of non-specific bone marrow, vascular and liver activity (Peltier et al, 1993).…”

Section: Resultsmentioning

confidence: 99%

“…Recently, a positive immunostaining for CgA in MTC has also been described: the staining for CgA correlates with the areas staining positively for calcitonin (Schmid et al, 1987). CgA is released by neuroendocrine tumours without physiological neuroendocrine stimuli and is present in a significant amount in the intracellular matrix of such tumours.Several studies have shown the capability of ISG performed with '"'I or "'In-labelled anti-CEA MAb to visualise MTC recurrences (Berche et al, 1982;Reiners et al, 1986;Edington et al, 1988;Manil et al, 1989;Zanin et al, 1990;O'Byrne et al, 1992;Vuillez et al, 1992). However, after injection of directly labelled MAb, image interpretation is sometimes difficult because of non-specific bone marrow, vascular and liver activity (Peltier et al, 1993).…”

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confidence: 99%

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Pretargeted immunoscintigraphy in patients with medullary thyroid carcinoma

Magnani

Paganelli²,

Songini³

et al. 1996

Br J Cancer

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Summary To evaluate the use of pretargeted immunoscintigraphy (ISG) in the diagnosis and follow-up of patients with medullary thyroid carcinoma (MTC), we studied 25 patients with histologically proven disease; ISG was repeated after surgery in two patients. The antibody, either an anticarcinoembryonic antigen (CEA) or an antichromogranin A (CgA) biotinylated monoclonal antibody (MAb) or a cocktail of the two biotinylated MAbs was first injected. After 24 h, avidin was administrated i.v., followed by "'In-labelled biotin 24 h later. Fifty-two lesions were visualised. Six primary tumours, diagnosed by increased calcitonin levels, were all correctly diagnosed; 47 recurrences, also suspected by blood tumour markers, were detected and confirmed by cytology or histology. In one case, single photon emission tomography allowed the detection of small lymph nodes with a diameter of 4 -7 mm. These lesions, not judged neoplastic by ultrasound, were confirmed to be neoplastic by fine needle aspiration. Pretargeted ISG correctly localises primary tumours and recurrences in MTC patients, when the only marker of relapse is serum elevation of calcitonin. With this three-step pretargeting method, cocktails of potentially useful MAbs can be used, avoiding false-negative studies that may occur when CEA or CgA are not expressed.Keywords: medullary thyroid carcinoma; monoclonal antibody; avidin-biotin Medullary thyroid carcinoma (MTC) arises from calcitoninsecreting parafollicular cells in the thyroid. Both the sporadic and the familial form are treated by surgery (Chong et al., 1975;Rossi et al., 1980), as the efficacy of radiotherapy is limited (Samaan et al., 1988) and chemotherapy is ineffective (Rougier et al., 1983;Brunt and Wells, 1987). Early diagnosis of recurrence or metastasis and accurate localisation of recurrent disease are very important prerequisites for successful surgical excision.Elevated serum calcitonin (Ct) is considered to be a marker for MTC. High serum levels of Ct and carcinoembryonic antigen (CEA) can often be found in patients with recurrent disease several years before it becomes clinically apparent, but, at present, no efficient and specific method is available for the localisation of recurrences.Morphological imaging techniques (ultrasonography, US; computerised tomography, CT; magnetic resonance imaging, MRI) are routinely used to confirm and localise a biologically detected recurrence but are not always adequate because of topographic polymorphism and the small size of tumour recurrences at an early stage of development (Schwerk et al., 1985;Frank et al., 1987;Crow et al., 1989).Several methods based on tumour avidity of non-specific radiopharmaceuticals such as [99"Tc](V)DMSA, '3I11231-MIBG and 20'T1 have also been designed for this purpose, with variable results (Arnstein et al., 1986;Hilditch et al., 1986;Baulieu et al., 1987;Clarke et al., 1987;Hilditch, 1987; Clarke et al., 1988;Hoefnagel et al., 1988;Guerra et al., 1989;Adams et al., 1990;Charkes et al., 1990;Udelsman et al., 1993).In the attem...

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Pretargeted immunoscintigraphy in patients with medullary thyroid carcinoma

Magnani

Paganelli²,

Songini³

et al. 1996

Br J Cancer

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“…The amount accumulated, however, is so low that detectable contrast from normal tissues cannot be reliably achieved by external scanning. Attempts to increase the tumour to normal tissue contrast have evaluated different isotopes (Fairweather et al, 1983b;Rainsbury, 1984) and different methods of scanning such as emission tomography (Berche et al, 1982). These techniques, however, are methods of improving the sensitivity of the detection of the very small amounts of labelled antibody accumulated by tumours.…”

Section: Discussionmentioning

confidence: 99%

Localisation of gastrointestinal cancer with a 131 I labelled monoclonal antibody to CEA

Allum¹,

Macdonald²,

Anderson³

et al. 1986

Br J Cancer

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“…The same MAb 23 was tested in an additional series of 16 patients with colorectal carcinoma and medullary thyroid carcinomas, using for the first time emission-computerized tomography (ECT) for detection of labeled antibodies (12,13). With this second generation of immunoscintigraphy, the results were encouraging in terms of sensitivity (16-17 tumors detected) but the signal-to-noise ratio was not very high, in part due to the poor detection efficiency of '" I by the camera and in part to the relatively low affinity of MAb 23.…”

Section: Introductionmentioning

confidence: 99%

Detection of colorectal carcinoma by emission-computerized tomography after injection of 123I-labeled Fab or F(ab')2 fragments from monoclonal anti-carcinoembryonic antigen antibodies.

Delaloye¹,

Bischof-Delaloye²,

Buchegger³

et al. 1986

J. Clin. Invest.

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177

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This clinical study was based on experimental results obtained in nude mice grafted with human colon carcinoma, showing that injected 131I-labeled F(ab)2 and Fab fragments from high affinity anti-carcinoembryonic antigen (CEA) monoclonal antibodies (MAb) gave markedly higher ratios of tumor to normal tissue localization than intact MAb. 31 patients with known colorectal carcinoma, including 10 primary tumors, 13 local tumor recurrences, and 21 metastatic involvements, were injected with '13I-labeled F(ab')2 (a = 14) or Fab (a = 17) fragments from MAb anti-CEA. The patients were examined by emission-computerized tomography (ECT) at 6, 24, and sometimes 48 h after injection using a rotating dual head scintillation camera. All 23 primary tumors and local recurrences except one were clearly visualized on at least two sections of different tomographic planes. Interestingly, nine of these patients had almost normal circulating CEA levels, and three of the visualized tumors weighed only 3-5 g. Among 19 known metastatic tumor involvements, 14 were correctly localized by ECT. Two additional liver and several bone metastases were discovered by immunoscintiraphy. Altogether, 86% of the tumor sites were detected, 82% with F(ab')2 and 89% with Fab fragments. The contrast of the tumor images obtained with Fab fragments suggests that this improved method of immunoscintigraphy has the potential to detect early tumor recurrences and thus to increase the survival of patients. The results of this retrospective study, however, should be confirmed in a prospective study before this method can be recommended for the routine diagnosis of cancer.

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Tomoscintigraphy for detecting gastrointestinal and medullary thyroid cancers: first clinical results using radiolabelled monoclonal antibodies against carcinoembryonic antigen.

Cited by 148 publications

References 8 publications

Pretargeted immunoscintigraphy in patients with medullary thyroid carcinoma

Pretargeted immunoscintigraphy in patients with medullary thyroid carcinoma

Localisation of gastrointestinal cancer with a 131 I labelled monoclonal antibody to CEA

Detection of colorectal carcinoma by emission-computerized tomography after injection of 123I-labeled Fab or F(ab')2 fragments from monoclonal anti-carcinoembryonic antigen antibodies.

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