Radioguided detection of a non-palpable occult lesion (ROLL) in a case of abdominal metastasis of a neuroendocrine tumor.

Neuroendocrine tumors (NET) are a heterogeneous group of neoplasms that originate in tissues derived from the neural crest, whose characteristic feature is the expression of neuroendocrine markers and somatostatin receptors. Here, we present the case of a patient with a surgically intervened small bowel NET. Focal uptake was identified in the unresected mesentery in the scintigraphy of somatostatin receptors (99mTc-Tektrotyd). A second intervention was performed with intraoperative radio-guided detection with a gamma probe and a handheld SPECT. An intraoperative radioguided technique allowed the detection of a lesion that was confirmed by histology to be a lymph node metastasis of the NET and a nodule of NET in the anastomosis of the first surgical intervention.

Stability of stabilized 99mTc-D,L-HMPAO stored in vials and syringes.

UNLABELLED: Our objective was to determine the stability of stabilized (99m)Tc-hexamethylpropylene amine oxime ((99m)Tc-d,l-HMPAO) dispensed by vial and syringe, with the storage time and labeling activity varied. METHODS: (99m)Tc-d,l-HMPAO was labeled according to the manufacturer's instructions, but with modification of the (99m)TcO(4)Na activity. Two groups were prepared: 1,110 MBq (30 mCi) and 2,600-3,700 MBq (70.3-100 mCi). Five minutes after labeling, the radiochemical purity (RCP) of the vial content was determined. Afterward, the same activity was distributed into two 2-mL syringes and into the manufacturer's vial. In one of the syringes, the radiopharmaceutical stayed in contact with the needle for 4 h. At 2 and 4 h after labeling, the RCP of the vial and syringe content was checked and compared. RESULTS: The mean RCP of stabilized (99m)Tc-d,l-HMPAO labeled with 1,110 MBq (30 mCi) and stored in a vial decreased from 93.1% at 5 min to 92.1% at 2 h and to 91.1% at 4 h. With storage in a syringe, the RCP decreased from 89.8% at 2 h to 88.7% at 4 h. This diminution increased for labeling with higher activities (2,600-3,700 MBq [70.3-100 mCi]), ranging from 91.4% at 5 min, 89.0% at 2 h, and 85.3% at 4 h in a vial and from 85.9% at 2 h to 80.2% in a syringe. (99m)TcO(2) and secondary (99m)Tc-HMPAO were the main impurities at t = 0. (99m)TcO(4)(-) was an impurity that increased with time in both vials and syringes but significantly so in syringes. All these impurities were higher with labeling activities in the range of 2,600-3,700 MBq (70.3-100 mCi). Contact of the needle with (99m)Tc-d,l-HMPAO sharply decreased the RCP to 57.1% at 4 h. CONCLUSION: The RCP of stabilized (99m)Tc-d,l-HMPAO decreases significantly in both vials and syringes with high labeling activities. The product is less stable when stored in a syringe than in a vial. The fraction of dose in contact with the needle affects the RCP results.

Effect of transport temperature on the Scantibodies total intact parathyroid hormone immunoradiometric assay using the RIAMAT-280.

BACKGROUND: Inadequate temperature affects the stability of intact parathyroid hormone (i-PTH) kits. Room temperature during transport modifies i-PTH results. METHOD: Percent bound (%B/Bmax) and concentrations (pmol/L) of standards, controls (C1, C2) and pool from eight standard curves were divided into: group I (three curves from kits kept at room temperature for more than 48 h) and group II (five curves from kits kept at 2-8 degrees C) during transport. i-PTH was measured using Scantibodies total i-PTH assay with RIAMAT-280. RESULTS: %B/Bmax for standards, C1 and C2 were significantly higher in group I versus II (P = 0.04). %B/Bmax for the pool were significantly lower in group I (P = 0.001). i-PTH pool concentration in group I was 51% lower (95% confidence interval, 47-53%, P = 0.001); differences were not significant for C1 (P = 0.25) and C2 (P = 0.57) in both groups. CONCLUSION: Room temperature on i-PTH kit during transport alters the standard curve, resulting in a decrease in i-PTH. Using a pool as internal quality control allows the detection of these changes not detected by kit controls.

Detección radioguiada de lesión oculta no palpable (ROLL) en un caso de metástasis abdominal de tumor neuroendocrino / No disponible

Los tumores neuroendocrinos (TNE) son un grupo heterogéneo de neoplasias que tienen origen en tejidos derivados de la cresta neural, que expresan marcadores neuroendocrinos y receptores de somatostatina. Presentamos el caso de una paciente con un TNE de intestino delgado previamente intervenido. En la gammagrafía de receptores de somatostatina (GRS/99mTc-Tektrotyd) se identificó un foco en mesenterio no resecado. Se realizó una segunda intervención con detección radioguiada con sonda gamma y con SPECT-portátil. Permitió detectar una lesión que se confirmó por histología como metástasis ganglionar de TNE y un nódulo de TNE en la anastomosis de la primera intervención quirúrgica

No disponible

Influence of the thyroid remnant in the elevation of the serum thyroglobulin after thyroidectomy in differentiated thyroid carcinoma. Importance of the diagnostic iodine total-body scanning.

PURPOSE: Stimulated thyroglobulin (Tg) and (131)I total-body scan (TBS) have been the mainstays of differentiated thyroid carcinoma (DTC), but now diagnostic TBS has been eliminated from some follow-up protocols. Nevertheless, Tg can be negative in the presence of thyroid tissue, and moderately elevated Tg poses management problems. The purpose of this study was to check how many patients have Tg negative but visible thyroid tissue and if diagnostic TBS could be clinically useful. MATERIAL AND METHODS: Retrospective review of 317 exams (stimulated Tg and TBS) of 128 patients with DTC. Patients with high-grade criteria and/or positive autoantibodies are excluded. Tg is considered positive if higher than the sensitivity level of the technique. TBS is positive if thyroid remnant, lymphatic node or metastases are detected. Results are classified in Tg and TBS concordant or discordant. RESULTS: Discordant (131)I TBS and Tg were found in 74/317 studies (23.3%), 48 (65%) being TBS positive and Tg negative. None of 128 patients had a first post-surgery negative scan, but 13 (10%) were Tg negative, even two patients with lymph node uptake. One year after radioiodine treatment, 26 out of 115 patients (initially Tg and TBS concordant positive) showed Tg negative and TBS still positive due to cervical remnants (20 patients), lymph node uptake (one) and metastasis (five); 20 patients remained Tg and TBS positive, but 14 of them only showed thyroid remnants. CONCLUSIONS: We propose to perform periodic diagnostic TBS to improve Tg specificity, at least while neck thyroid activity is detected, even if Tg is negative.