Detection of pelvic recurrence of colorectal carcinoma: prospective, blinded comparison of Tc-99m-IMMU-4 monoclonal antibody scanning and CT.

PURPOSE: To prospectively compare the accuracy of imaging with technetium-99m-labeled Fab' fragment of the anti-carcinoembryonic antigen antibody (CEA) IMMU-4 with that of computed tomography (CT) for the detection of pelvic recurrence of colorectal carcinoma. MATERIALS AND METHODS: In 61 patients, blinded interpretations of both modalities were correlated with surgical-pathologic (n = 23) or clinical and CT follow-up findings (n = 38). RESULTS: Sensitivity and specificity with antibody scanning alone and combined with CT (79% and 84% vs 83% and 81%, respectively) were not significantly different from those values for CT alone (66% and 97%, respectively). Sensitivity of antibody scanning was greater for recurrences larger than 2 cm (94% vs 55% [P = .02]), serum CEA more than 2.5 ng/mL (91% vs 40% [P = .03]), and combined planar and single photon emission CT antibody scanning compared with planar alone (79% vs 48% [P = .03]), without a significant decrease in specificity. CONCLUSION: Antibody scanning does not improve on findings at CT alone for recurrent colorectal carcinoma but can help differentiate recurrent tumor from fibrosis.

Development of Kondh women.

PIP: This article presents a profile of the living conditions of the Kondh ethnic group, with particular attention to women's conditions. The Kondhs are the largest tribal community in Orissa state, India. Kondh tribes are concentrated in Phulbani, Koraput, and Kalahandi districts. The Kondh consist of three subgroups. In Phulbani district the Kondh are one of several tribal populations and together with scheduled castes and tribes are the dominant populations. Phulbani district has limited educational resources and low levels of literacy, particularly among women. Female literacy in 1991 was only 16.59%. Girl's educational institutions are few in number and poor in quality. Female literacy is low due to parental ignorance of the importance of female education, the need to use girl children as domestic helpers, the cultural practice of facial tattooing that causes injury and shame among parents and children, the inadequacy of district schools, and the reputation of better private boarding as "cages." Economic life is based on a sexual division of labor, and women and men work according to their capacity. Agricultural tasks are shared, but men perform ploughing and clearing of jungle. Women perform all domestic tasks in addition collection of daily firewood and additional forest products that are sold jointed with husbands in local markets. During the slack agricultural periods, men relax and women work. Both men and women work if construction work is available nearby. Although tubewells were installed in villages, women prefer distant pond or stream water for drinking. The loss of tribal land for women places them in more vulnerable sexual and economic positions. Many voluntary groups promote land ownership for women as a means of security and social status. Phulbani district has little urbanization and no major industries. Bride-price was replaced by dowry, which downgrades Kondh women's status. The Kondh suffer from malnutrition, malaria, and anemia. Health services are insufficient, and Kondh cultural practices interfere with acceptance of modern medicine and healthy lifestyles.^ieng

Abdominal staging of thoracic Hodgkin disease: CT-lymphangiography-Ga-67 scanning correlation.

A retrospective study was performed to assess whether lymphangiography and gallium-67 scanning were complementary to computed tomography (CT) in abdominal staging of disease in 94 patients with early-stage thoracic Hodgkin disease. In 51 patients with surgical or follow-up correlation, the spleen was involved in 16% (n = 8), the spleen and lymph nodes in 22% (n = 11), and only lymph nodes in 2% (n = 1). In these 51 patients, none of the imaging modalities had greater than 50% sensitivity for the detection of nodal involvement. The overall accuracy was similar (71%-82%) for each modality. Analysis of subgroups of patients with lymph nodes measuring less than 10 mm, 10-19 mm, or 20 mm or greater at CT revealed that lymphangiography and gallium scanning added little to the positive or negative predictive values of CT. The sensitivity of CT for detection of splenic disease was 11% (two of 19). On the basis of surgical or follow-up correlation in 51 patients, the authors conclude that lymphangiography and gallium scanning offer minimal or no complementary benefit.

Procarbazine-induced interstitial pneumonitis with a normal chest x-ray: a case report.

Pulmonary toxicity due to cytotoxic drugs is well described in the literature. This is most commonly described in association with bleomycin, busulfan, and methotrexate. This report presents a case of interstitial pneumonitis with a normal chest x-ray that is most certainly due to procarbazine. In addition, the role of gallium-67 citrate scintigraphy in early diagnosis is discussed. This is especially important since discontinuation of the drug before radiographic manifestations of pulmonary toxicity become evident may prevent permanent pulmonary injury and its sequelae.

Necropsy of a cadaver containing 50 mCi of sodium131 iodide.

A patient who received an oral dose of iodine-131 for the treatment of metastatic thyroid carcinoma unexpectedly died with a large total-body retention of the radioiodine. An autopsy was required and the family requested the body to be transported out of state to their home town. Since the radiation intensity near the surface of the cadaver was above 200 mR/hr, advanced planning and special precautions were necessary in order for the autopsy to proceed safely. This required the immediate cooperation of the pathologists, nuclear medicine physicians, health physicists, an endocrine oncologist, and other hospital staff. As a result of team efforts, personnel radiation exposures were kept as low as reasonably achievable, contamination of the autopsy room was minimal, and the radiation level of the cadaver was adequately reduced for safe transport and burial.

Radiogallium scan in P. carinii pneumonia.

A gallium scan performed on a patient with fever of unknown origin (FUO) revealed an abnormal uptake of radiotracer in the lungs despite negative chest roentgenographic examination and other routine diagnostic studies. Subsequent lung biopsy results confirmed the presence of Pneumocystis (P.) carinii infection. A repeat gallium scan obtained following appropriate antibiotic therapy was essentially normal. The importance of radiogallium scanning in an immunosuppressed patient with FUO is emphasized.

Radiotracer uptake in medullary carcinoma of the thyroid.

A patient with pathologically confirmed medullary carcinoma of the thyroid with lymph node metastases was noted to show uptake of radiothallium, radiopertechnetate, and radioiodine. A perchlorate washout test was markedly positive, indicating that the uptake was largely due to trapping.

Significance of 99mTc-sulfur colloid splenic image in malignant melanoma.

To evaluate the clinical significance of 99mTc-sulfur-colloid (TsSC) spleen scan findings in patients with malignant melanoma, a retrospective study was undertaken. Eighty-one patients with histologically proven malignant melanoma who received treatment in Roswell Park during a five-year period were included in this study. The scans were analyzed for spleen size, differential uptake of the tracer in liver and spleen, and for the presence of metastases in these two organs. These data were compared with stage of disease, survival, and autopsy findings. Significant correlation was found between the splenic size as measured on the scintiscan and at autopsy examination. The spleen size was found to be normal in 92% of the patients in early melanoma. The median survival of patients who had a normal-sized spleen by scan criteria was found to be longer than those who had splenomegaly. No significant difference in survival was noted between the patients with and without augmented splenic uptake of TcSC. Only a small number (17.7%) of patients with augmented splenic uptake had splenic metastases; hence, the possible role of immunological factors was considered.

Bone scintigrams: their clinical usefulness in patients with breast carcinoma.

A comparison of bone scintigrams and roentgenographic skeletal surveys, obtained on 170 patients with breast carcinoma, was made to evaluate the diagnostic efficacy of these techniques in detecting metastatic bone lesions. The bone scans were abnormal in 81 patients, while the roentgenograms were abnormal in only 51. In 34 of the 81 (42%) patients with abnormal bone scans, there was no radiographic evidence of a benign lesion to account for the increased ratiotracer uptake; and the abnormalities noted on the bone scans were proven to be bony metastases on follow-up examinations. In the remaining 47 patients with positive bone scintigrams, both the scans and the roentgenograms were abnormal; however, in 23 patients the bone scan demonstrated significantly more lesions than what the roentgenograms had revealed. This study confirms that bone scan is superior to roentgen surveys in detecting skeletal metastases in patients with breast carcinoma. It was noted that the metastatic lesions can be visualized on the scans earlier than they are apparent on the X-rays by a mean interval of 4 months.

Abnormal gallium scan in regional enteritis.

Regional enteritis in a 41-year-old woman was localized on a 67Ga-citrate scan, appearing as a well-circumscribed abnormality in the pelvis simulating an abscess or a malignant neoplasm. Gallium-67-citrate scintigraphy is useful in localizing granulomatous inflammations including regional enteritis, and its use may be beneficial in evaluating the extent and the state of disease process.

Detection of bone metastases in urogenital malignancies utilizing 99mTc-labeled phosphate compounds.

A retrospective study of 99 patients with proved urogenital malignancies was done to determine the value of bone scanning versus roentgenographic skeletal survey in assessing the degree of metastatic involvement. Findings on bone scans were positive in 59 patients, and in 7 of these patients results of roentgenographic skeletal survey were negative; 11 additional patients had only minimal roentgenographic abnormalities in contrast to more extensive involvement demonstrated by bone scanning.

Localization of metastatic adrenal carcinoma utilizing 67Ga-citrate.

Soft tissue metastases from left adrenal cortical carcinoma in a 30-year-old white man were localized on a gallium scintigram six weeks following left adrenalectomy.

The value of 67Ga scintigraphy in soft-tissue sarcoma and chondrosarcoma.

Forty-one 67Ga images were obtained for 33 patients with a diagnosis of soft-tissue sarcoma or chondrosarcoma. Tumor was detected in 27 cases of soft-tissue sarcoma; 25 (93%) of these were found on the Ga scans. The overall accuracy of scanning was 95.1%. All patients with positive scans had tumor present. In soft-tissue sarcoma patients the scan detected the tumor in 39 out of 45 sites. Ga scintigraphy was found to be useful in the initial evaluation and follow-up of these patients. If the Ga citrate scan is positive at multiple sites, the possibility of tumor being present is 100% with a false negative rate of 16%.

Gallium-67-citrate scanning for the localization and staging of lymphomas.

One-hundred-eight 67Ga-citrate scans were evaluated in Hodgkin's and non-Hodgkin's lymphomas for staging, diagnosis of recurrence, and for determing the results of treatment. Accuracy as confirmed by comparing the scans with pathologic material or roentgenologic and clinical findings was found to be 83%. Known lymph node involvement was diagnosed correctly in 87% but accuracy was only 48% for extranodal areas. Bone lesions were diagnosed correctly in 83% compared with only 48% of lesions of the lungs and liver. Scans were 75% accurate in 28 patients scanned for initial staging. False negatives were present in 12%; recurrent tumor in an area of prior radiation therapy appeared to be the most common cause. There were 5% false positives. Gallium scanning is a useful adjunct to other methods of detecting lymphoma.