Imaging of pharyngeal and laryngeal carcinomas with indium-111-labeled monoclonal anti-CEA antibodies.

Localization of primary tumors, metastases, or recurrences in 13 consecutive patients with histological verification of squamous cell or adenocarcinoma was made with radioimmunodetection using monoclonal radiolabeled anti-CEA antibody. All surgical specimens stained immunohistochemically, except one, were positive for CEA. Of the known 19 tumor sites 17 were visualized in antibody scans. There were two positive findings that did not prove to be positive during 12 month follow-up. The scintigram findings did not correlate with CEA serum concentrations that, with one exception, were normal in all patients.

Radioimmunodetection of chemodectoma by In-111 labeled anti-CEA antibody. Case report and review of the literature.

The carotid body paraganglioma is a rare tumor that arises from the autonomic nervous chemoreceptor. It can be diagnosed by contrast angiography. A patient in whom a carotid body chemodectoma was imaged with In-111 labeled monoclonal anticarcinoembryonic antigen (anti-CEA) antibodies is described. There was marked accumulation of the antibody into the tumor but little blood pool activity at 25 hours. The removed tumor, which was examined immunohistochemically, was positive for vimentin, GFAP, NF 68, SYP, and S-100; and negative for CEA, desmin, and cytokeratin. The tumor was a paraganglioma that accumulated antibody with nonspecific mechanism of uptake.

Idiopathic, inflammatory, medial meatal, fibrotising otitis presenting with lichen planus.

BACKGROUND: Of the acquired ear canal atresias, idiopathic, inflammatory, medial meatal, fibrotising otitis has been suggested as a distinct disease entity, for reasons of aetiology. OBJECTIVE: To report three more cases of idiopathic, inflammatory, medial meatal, fibrotising otitis and to further consider the possible relationship between this condition and lichen planus. PATIENTS: Three adult patients with idiopathic, inflammatory, medial meatal, fibrotising otitis, two with bilateral aural symptoms, treated and followed up at the department of otorhinolaryngology of Helsinki University Hospital. RESULTS: We found idiopathic, inflammatory, medial meatal, fibrotising otitis, affecting solely the glabrous skin of the osseous part of the external ear canals, in three patients who also suffered from severe oral lichen planus. CONCLUSIONS: The aetiopathology or pathophysiology of idiopathic, inflammatory, medial meatal, fibrotising otitis may be linked with lichen planus. Early, active treatment of idiopathic, inflammatory, medial meatal, fibrotising otitis with local corticosteroids may prevent total medial meatal atresia.

Radioimmunodetection of head and neck cancer. A review.

Radiolabeled antibodies can add a dimension in the diagnostic imaging and staging of metastatic head and neck malignancies. In the oral cavity, oropharynx and larynx the vast majority of malignancies are squamous cell carcinomas. This common cellular origin makes it feasible to search these neoplasms for appropriate tumor-associated antigens which can be used for radioimmunoscintigraphy. The pretherapeutic staging of head and neck malignancies, including salivary gland tumors, is based on clinical findings and conventional radiology (computerized tomography, magnetic resonance imaging, ultrasonography). The routine use of monoclonal antibodies for imaging head and neck malignancies was made possible by the production of several monoclonal antibodies to tumor-associated membrane antigens. A review of the clinical trials reported in the literature, and our own results with 111In-labeled anti-carcinoembryonic antigen (CEA) antibody in 42 patients are presented.

Immunoscintigraphy in laryngeal and pharyngeal carcinomas using indium-111 labelled monoclonal antibody.

Localization of primary tumors, metastases or recurrences in 13 consecutive patients with histological verification of squamous cell or adenocarcinoma was determined with radioimmunoscintigraphy using monoclonal radiolabelled anti-CEA-antibody. In 12 of the 13 cases, immunohistochemical stainings were positive for CEA. Correct radioimmunoscintigraphic localization was obtained in 15 of the 19 surgically verified tumor sites. There were two positive scintigraphic findings which could not be verified during one year follow-up. The CEA serum concentrations were with one exception normal in all patients, showing that the serum CEA level does not predict the possible benefit from anti-CEA radioimmunoscintigraphy.

Diagnosis of tumors of the parotid gland with anti-CEA immunoscintigraphy.

Twenty-nine consecutive patients with a palpable unilateral tumor in the parotid gland region had scintigraphy 22-28 hr after they were injected with 111In-labeled monoclonal anti-carcinoembryonic antigen (CEA) antibody (F023C5). Two patients were imaged at 48 hr also, and one patient was imaged additionally with single-photon emission CT. Twenty-seven of the patients had surgery within 2-3 weeks. The serum CEA concentrations were normal in 27 of 29 patients. Immunoglobulin G human anti-murine-antibody concentrations were elevated in three of 20 patients. Ten patients had scintigraphic findings suggesting a malignant tumor, six of them had histologically proved malignant tumors. The tumors associated with positive immunoscintigrams were stained immunohistochemically with anti-CEA, and four of the malignant tumors were positive in immunohistochemical staining. The results suggest that nonspecific anti-CEA-antibody imaging is helpful in predicting the presence of a malignant tumor in the parotid area. The radioantibody method could provide useful clinical information that has a high negative predictive value.

Imaging of tumours in the parotid region with indium-111 labelled monoclonal antibody reacting with carcinoembryonic antigen.

Twenty-nine consecutive patients with palpable unilateral tumour in the parotid gland region were examined by planar scintigraphy at 22-28 h after injection of 111In-labelled monoclonal anti-CEA-antibody. Two patients were also examined with emission tomography. Twenty-seven of the patients were operated on within 2-3 weeks. The serum CEA concentration was measured in 28 of the patients and was normal in all of them. Ten patients had positive scans and six of these had histologically malignant tumours; only four of the tumours with positive immunoscintigram were stainable immunohistochemically with anti-CEA. No patient with negative scintigram had parotid malignancy.

Imaging of a parapharyngeal hemangiopericytoma. Radioimmunoscintigraphy (SPECT) with indium-111-labeled anti-CEA antibody, and comparison to digital subtraction angiography, computed tomography, and immunohistochemistry.

A 27-year-old male patient with a parapharyngeal hemangiopericytoma was investigated radiologically with orthopantomography, computed tomography, and digital subtraction angiography before the operation. Because a malignancy was suspected, the patient was imaged with gamma camera using radiolabeled monoclonal anticarcinoembryonal antigen antibody including single photon emission computed tomography. The radioantibody accumulated strongly into the neoplasm. Tumor to background ratio was 2.2. Samples of the excised tumor were stained immunohistochemically for desmin, vimentin, muscle actin, cytokeratin, CEA (carcinoembryonic antigen), and factor VIII. They showed that the antibody uptake was of unspecific nature and not due to CEA expression in the tumor.

Radioimmunoimaging of glomus tympanicum tumors by In-111 labeled monoclonal antibody using single photon emission computed tomography.

OBJECTIVE: This study aimed to evaluate the diagnostic value of radioimmunoimaging by radionuclide-labeled monoclonal antibody F023C5 (MAb), raised originally against carcinoembryonic antigen (CEA), in patients with glomus tympanicum tumors. STUDY DESIGN: Prospective. SETTING: Preoperative imaging versus radioactivity of removed tumor. PATIENTS: Two patients with paraganglioma (glomus tympanicum). INTERVENTION: Diagnostic. MAIN OUTCOME MEASURE: Radiolabeled MAb accumulates in paraganglioma tissue. Single photon emission computed tomography (SPECT) provides improved detection of lesions. RESULTS: SPECT using F023C5 MAb detected the abnormal accumulation of radioactivity in the middle ear region. This method detected paraganglioma less than 1 cm in diameter. CONCLUSIONS: Successful detection of glomus tympanicum in two patients using In-111-labeled F023C5 MAb is reported. The result suggests the radioimmunoimaging using this antibody is useful for the detection of not only primary glomus tumors, but also of local recurrence and unsuspected lesion in patients with paragangliomas.

A low pH 111In-bleomycin complex: a tracer for radiochemotherapy of head and neck cancer.

Bleomycin (BLM) is a well known natural antibiotic. It is toxic to dividing cells and has been used for the treatment of several forms of cancer. BLM has been labeled with various cations, but most of them have turned out be unstable in in-vivo experiments. In-BLM demonstrated high bone marrow uptake, but using 111In-bleomycin complex (BLMC) formed at low pH, the low in vivo stability and high bone marrow seeking behavior of the molecule could be avoided. The idea of using BLMC in combined radiotherapy and chemotherapy is intriguing. In this study we examined the effects of 111In-A'2a-c-BLMC in the treatment of 31 head and neck cancer patients. Findings were compared with those of surgery, and pre-operative radiology. The injected activity was 85-110 MBq, and the specific activity was approximately 100 MBq/mg. The half-life of 111In activity in serum varied from 1.5 to 3.1 hours. Maximum activity in the urine was achieved in all patients within 3 hours, and the average half-life in urine was 2 hours. In most patients 50% was excreted within 3 hours, in some 70%; in all patients > 95% of the activity was excreted within 22 hours. In surgical samples from 24 patients the best tumor-to-tissue ratios were: fat 60:1, bone 17:1, muscle 12:1, blood 3.6:1. All patients were examined on the injection day with ultrasonography of the neck. Using 111In-BLMC we missed a few small lymph nodes in 2 patients, but there were no false positive findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Spin lock and magnetization transfer imaging of head and neck tumors.

PURPOSE: To evaluate and compare the spin lock and magnetization transfer techniques in the differentiation of benign and malignant head and neck tumors at magnetic resonance (MR) imaging. MATERIALS AND METHODS: Forty consecutive patients with histologically verified head and neck tumors (20 malignant and 20 benign tumors, including five infections) were studied with a 0.1-T MR unit. The spin lock and magnetization transfer effects were defined as 1-(signal intensity with stronger preparation pulse/signal intensity with weaker preparation pulse). RESULTS: A strong correlation between the spin lock and magnetization transfer effects was found (r = 85, P < .001). With a spin lock effect of 0.48 and a magnetization transfer effect of 0.32 as the thresholds, sensitivity for detecting a malignant tumor was 95% and 94%, respectively, and specificity was 60% and 65%. CONCLUSION: Low spin lock and magnetization transfer effects are characteristic of benign tumors. High spin lock and magnetization transfer effects were associated with malignancy, but there were overlapping values for salivary gland infections, some benign tumors, and malignancies. The spin lock technique seems to be an effective method for generating magnetization transfer-based contrast in the head and neck tumors.

T1 rho dispersion imaging of head and neck tumors: a comparison to spin lock and magnetization transfer techniques.

The potential of T1 rho dispersion, spin lock (SL), and magnetization transfer (MT) techniques to differentiate benign and malignant head and neck tumors was evaluated. Twenty-four patients with pathologically verified head and neck tumors were studied with a .1-T MR imager. T1 rho dispersion effect was defined as 1 -(intensity with lower locking field amplitude/intensity with higher locking field amplitude). T1 rho dispersion effects were higher for malignant than benign tumors (P = .001). With T1 rho dispersion effect .14 as the threshold, sensitivity for detecting a malignant tumor was 91%, specificity was 77%, and accuracy was 83%. A strong correlation between T1 rho dispersion effects and SL effects and between T1 rho dispersion effects and MT effects in the head and neck tumors was found (r = .87, P < .001 and r = .90, P < .001, respectively). High T1 rho dispersion effects are not specific indicators of malignancy, because chronic infections, some benign tumors, and malignancies may overlap. Low T1 rho dispersion effect values are characteristic of a benign tumor.