(dtpa-phe(1))-octreotide and Breast-Neoplasms

[(111)In-DTPA(0)]octreotide is a radiopharmaceutical with a great potential for the visualization of somatostatin receptor-positive tumors. The overall sensitivity of Somatostatin Receptor Imaging (SRI) to localize neuroendocrine tumors is high. In a number of neuroendocrine tumor types, as well as in Hodgkin's disease, inclusion of SRI in the localization or staging procedure may be very rewarding, either in terms of cost-effectiveness, patient management, or quality of life. The value of SRI in patients with other tumors, like breast cancer, or in patients with granulomatous diseases, has to be established. The development of Peptide Receptor Radionuclide Therapy (PRRT) is expected to stimulate peptide receptor imaging.

Topics: Brain Neoplasms; Breast Neoplasms; Carcinoma, Small Cell; Humans; Indium Radioisotopes; Lung Neoplasms; Lymphoma; Neuroendocrine Tumors; Octreotide; Pentetic Acid; Radionuclide Imaging; Receptors, Somatostatin; Sarcoidosis

The study of breast carcinogenesis is complicated by the heterogeneity of the disease. One way of simplifying is to subdivide these tumors into clinically relevant subgroups. There are indications that breast carcinomas, of which some express the somatostatin receptor (SS-R), can be divided this way. Expression of somatostatin receptors (SS-R's) in human primary breast cancer has a very high incidence. This can be demonstrated by in vitro autoradiography and in vivo by somatostatin receptor scintigraphy. However the clinical significance of somatostatin receptor expression in human breast cancer needs to be investigated. In this review article we summarize the current understanding of the functional role of somatostatin receptors in human breast cancer. Their relationship with neuroendocrine differentiation of the cancers and genetic and patient characteristics, the role of in vivo SS-R's visualization, and the possible medical and radiotherapeutic implications of these findings are discussed.

Topics: Autoradiography; Breast Neoplasms; Carcinoma; Cell Differentiation; Female; Gene Expression Regulation, Neoplastic; Humans; Indium Radioisotopes; Neuroendocrine Tumors; Octreotide; Pentetic Acid; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Receptors, Somatostatin; Terbium

Secondary tumours of any type in the breast are rare. A review of the literature demonstrated only 23 cases of carcinoid tumours with associated breast metastasis, as distinct from primary carcinoid tumours of the breast. Distant metastases from carcinoid tumours are correlated with poor prognosis and survival. Although both primary and metastatic mammary carcinoid tumours are uncommon, the recognition of the true origin of the tumours may be of importance owing to the different clinical management and prognosis of the two conditions. Recently, radionuclide-labelled imaging techniques have been applied to the localization of such lesions, based on isotope uptake by receptors present in these neuroendocrine tumours. We report two new cases of carcinoid tumours with breast metastases, the primaries being in the ileocaecal valve and the bronchus, respectively. The diagnosis of a carcinoid tumour was based on the clinical, biochemical, histopathological and immunostaining features. Furthermore, these patients had both 123I-MIBG and 111In pentetreotide scintigraphy performed. These radionuclides play a useful role in the localization and potentially in the management of carcinoid tumours and their distant metastases.

Topics: 3-Iodobenzylguanidine; Adult; Antineoplastic Agents; Breast Neoplasms; Bronchial Neoplasms; Carcinoid Tumor; Female; Humans; Ileal Neoplasms; Ileocecal Valve; Indium Radioisotopes; Iodine Radioisotopes; Octreotide; Pentetic Acid; Radionuclide Imaging; Radiopharmaceuticals

[111In-DTPA-D-Phe1]-octreotide scintigraphy has been shown to reveal somatostatin receptor-positive lesions in the majority of primary breast cancers. We have recently developed a panel of somatostatin receptor subtype-specific antibodies that effectively stain formalin-fixed, paraffin-embedded breast cancer tissue. However, it is uncertain to what extend somatostatin receptors detected during immunohistochemical staining represent functional binding sites responsible for high tracer uptake during somatostatin receptor scintigraphy.. We, therefore, conducted a prospective study in which 23 patients with suspected breast tumors were included. All patients received [111In]-pentetreotide scintigraphy. After surgical removal of the tumor, the somatostatin receptor status was determined by immunohistochemistry.. Among 20 pathologically proven malignant tumors (14 ductal and six lobular carcinomas), 13 (approximately 65%) were scintigraphically visible. Of the 20 primary breast cancer specimens analyzed, three tumors (approximately 15%) were positive for sst1, nine (approximately 45%) revealed immunoreactive sst2A receptors, eight (approximately 40%) showed sst3-like immunoreactivity, and 14 (approximately 70%) were positive for sst5. There was an excellent correlation between the outcome of somatostatin receptor scintigraphy and expression of sst2A (P = 0.025) as well as sst5 (P < 0.001) but not expression of either sst1 (P = 0.343) or sst3 (P = 0.400).. Both sst2A and sst5 can be responsible for high tracer uptake during [111In]-pentetreotide scintigraphy in primary breast cancer. Thus, somatostatin receptor scintigraphy may possibly be of value in the detection of proven somatostatin receptor sst2A- and/or sst5-positive lesions in metastatic breast cancer.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Breast Neoplasms; False Negative Reactions; Female; Humans; Immunohistochemistry; Indium Radioisotopes; Middle Aged; Octreotide; Pentetic Acid; Prospective Studies; Radionuclide Imaging; Receptors, Somatostatin

Some breast tumors are classified as primary neuroendocrine carcinomas because of argyrophilia and positivity for neuroendocrine markers (chromogranins A and B and neuron-specific enolase), regardless of their cellular rest and cord structures. Tc-99m sestamibi has been widely used to identify epithelial breast carcinoma and lymph node metastases, whereas In-111 DTPA-octreotide has been used to identify primary and secondary neuroendocrine neoplasms specifically. The use of In-111 DTPA-octreotide and Tc-99m sestamibi scintigraphy in a woman with neuroendocrine differentiated cancer of the left breast is reported. Uptake of these radiopharmaceuticals only in the breast tumor permitted identification of a primary breast carcinoma, whereas absence of In-111 DTPA-octreotide uptake in other sites helped to exclude the presence of other neuroendocrine neoplasms in other organs.

Topics: Aged; Breast Neoplasms; Carcinoma; Carcinoma, Neuroendocrine; Diagnosis, Differential; Female; Humans; Indium Radioisotopes; Octreotide; Pentetic Acid; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sestamibi; Terbium

Indium-111 octreotide and thallium-201 scintigraphic studies were compared in 21 patients (16 with palpable and five with non-palpable lesions) suspected of having breast malignancies on the basis of mammography. Early (15 min) and late (3 h) 201Tl (111 MBq) and 4-h and 24-h 111In-octreotide (111-148 MBq) static planar anterior images (matrix 256 x 256) were obtained on separate days. Images were evaluated both visually and quantitatively. Biopsy was performed following the imaging studies. Histopathology revealed 17 breast carcinomas (15 cases of invasive ductal carcinoma, one mucinous adenocarcinoma and one intraductal carcinoma) and four benign breast lesions (two fibroadenomas, one abscess and one case of fat necrosis). The means histopathological tumour size (mean largest diameter) was 3.38 +/- 1.9 cm. 111In-octreotide detected 16 of the 17 breast cancers (94%) while 201Tl detected 13 of them (76%). Both 111In-octreotide and 201Tl missed one non-palpable carcinoma showing only an isolated cluster of microcalcifications on mammography. The smallest tumour size detected by both agents 1.5 x 1.5 cm. Of the four benign lesions, only the breast abscess revealed both 201Tl and 111In-octreotide uptake. 111In-octreotide scan also showed tracer uptake in five of the six patients with histologically proven axillary metastases, while four of these six patients showed 201Tl uptake. The tumour/background (T/B) ratios of late 111In-octreotide and 201Tl images were 1.71 +/- 0.38 and 1.46 +/- 0.30 respectively (P = 0.039). In this preliminary study, 111In-octreotide yielded more favourable results than 201Tl in the detection of breast carcinomas. However, the diagnostic efficacy of 111In-octreotide imaging needs to be investigated in larger patient series.

Topics: Breast Diseases; Breast Neoplasms; Carcinoma, Ductal, Breast; Female; Humans; Indium Radioisotopes; Mammography; Middle Aged; Octreotide; Pentetic Acid; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Thallium Radioisotopes; Time Factors

Topics: Adult; Breast Neoplasms; Diagnosis, Differential; Female; Hodgkin Disease; Humans; Indium Radioisotopes; Liver Neoplasms; Male; Mediastinal Neoplasms; Middle Aged; Neoplasm, Residual; Octreotide; Pelvic Neoplasms; Pentetic Acid; Radionuclide Imaging; Remission Induction