(dtpa-phe(1))-octreotide and Sarcoidosis

[(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

This study aimed to evaluate the diagnostic utility of 111In-DTPA-D-Phe1-octreotide scintigraphy in the different situations that can be present when an examination is requested during the clinical course of the carcinoid tumor (CT).. We have performed 41 scintigraphies with 111In-octreotide (145-185 MBq) in 35 patients (19 females and 16 males) with clinically suspected or confirmed CT. The patients were classified into five groups: Group A: Indolent symptoms of CT (n=9); B: CT staging located in lung (n=4), stomach (n=2), cecum (n=1), thymus (n=1) and pancreas (n=1); C: Carcinoid syndrome (n=1); D: CT staging after surgery located in pancreas (n=1), ovary (n=1), cecum (n=1), stomach (n=1), appendix (n=1) and ileum (n=1); and E: Post-treatment follow-up (n=13), with CT located in bronchial tree (n=5), small intestine (n=3), appendix (n=2), thymus (n=1), ovary (n=1) and unknown primary tumor (n=1). Three patients of this group had one scintigraphic study before the treatment. Head and neck, thorax and abdomen images were obtained at 4 and 24 h in all of the patients and SPECT images of the abdomen (n=14), thorax (n=10), and brain (n=1) were obtained at 24 h in 25 patients.. Group A: In the 3 patients with a positive scintigraphy, the definitive diagnosis was meningioma, Hurtle cell's carcinoma and lung adenocarcinoma. The clinical follow-up in the six other patients, at least during one year, did not show any evidence of CT. Group B: Six of the 9 CT were detected with the scintigraphy. In 2 cases of bronchial CT, the scan showed sarcoidotic regional lymph node involvement and CT hepatic and bone metastases, respectively. Group C: The scintigraphy detected hepatic metastases from an unknown primary tumor. Group D: The scintigraphy was positive in 3 cases (hepatic or/and abdominal metastases) and was normal in the other 3. The scintigraphy was negative in one patient with peritoneal metastases. Group E: The scintigraphy was normal in 7 patients in concordance with the clinical follow-up. In 3 patients with a scintigraphy performed prior to treatment, the scintigraphy detected recurrence (thymic CT), progression of the metastatic disease (ovarian CT) and partial regression of the hepatic metastases (carcinoid syndrome). In the three other patients, the scintigraphy showed metastases located in liver in one patient and hepatic and extra-hepatic metastases in the two other patients. The sensitivity and specificity of 111In-Octreotide in the detection of the primary tumor and metastases were 72% and 84% respectively.. The 111In-Octreotide scintigraphy has a low diagnostic utility in patients with indolent symptoms of CT. However, it is the first line of diagnosis for the staging of the CT and to evaluate the follow up after therapy.

Topics: Adult; Aged; Bone Neoplasms; Brain Neoplasms; Carcinoid Tumor; Diagnosis, Differential; Digestive System Neoplasms; Female; Follow-Up Studies; Humans; Liver Neoplasms; Lung Neoplasms; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Proteins; Octreotide; Pentetic Acid; Radiopharmaceuticals; Receptors, Somatostatin; Sarcoidosis; Thymus Neoplasms; Thyroid Neoplasms; Tomography, Emission-Computed, Single-Photon

We describe two cases of bronchial carcinoid tumour detected by (111In-DTPA-D-Phe1)-octreotide scintigraphy. The SPECT of the thoratic region provided a better images of the primary tumour than the planar images. In one of the patients, the bronchial carcinoid tumour was associated with sarcoidosis, which led to an erroneous evaluation of the extension of the tumour.

Topics: Adult; Biopsy; Bronchi; Bronchial Neoplasms; Carcinoid Tumor; Female; Humans; Indium Radioisotopes; Lung; Lung Diseases; Lymphatic Diseases; Middle Aged; Octreotide; Pentetic Acid; Radiography, Thoracic; Radiopharmaceuticals; Sarcoidosis; Terbium; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Scintigraphy using a long lived radiolabelled somatostatin analogue [111In-DTPA-D-Phe1]-octreotide (OctreoScan) has previously been shown to be useful in the detection and management of neuroendocrine tumours, as well as in the imaging of various other malignant tumours. It was recently reported that the radiopharmaceutical accumulates also in the granulomatous lesions in Wegener's disease and in sarcoidosis. The present study was undertaken in order to evaluate the usefulness of the technique in detection of extrathoracic manifestations.. OctreoScan scintigraphy was performed in 5 patients with biopsy-proven sarcoidosis. A patient with a familial history of multiple endocrine neoplasia served as control.. In 4/5 patients previously unknown granulomas were registered, and in the remaining subject the findings at the physical examination were confirmed.. We conclude that somatostatin analogue scintigraphy may be helpful in finding extrathoracic granulomatous lesions in sarcoidosis, thus providing good prerequisites for focused biopsy attempts.

Topics: Adult; Biopsy; Female; Humans; Indium Radioisotopes; Male; Middle Aged; Octreotide; Pentetic Acid; Radionuclide Imaging; Radiopharmaceuticals; Sarcoidosis

Normal as well as activated lymphocytes and macrophages have previously been shown by radioreceptor analysis to express somatostatin receptors (SS-R). The somatostatin (SS) analogue [111In-DTPA-D-Phe1]octreotide (111In-octreotide) is already used successfully in the visualization of a variety of neuro-endocrine tumours and malignant lymphomas. In the present study 20 consecutive patients were investigated, 12 with sarcoidosis, one with both sarcoidosis and aspergillosis, four with tuberculosis and three with Wegener's granulomatosis. For in vivo SS-R imaging, total-body scintigraphy was performed 24 and 48 h after the administration of 111In-octreotide. Granuloma localizations could be visualized in all patients studied; additional sites were found in nine patients with sarcoidosis and in two patients with tuberculosis. In vitro autoradiography of fresh tissue biopsies, using the SS analogue [125I-Tyr3]octreotide, showed binding at sites that were microscopically identified as granulomatous inflammation. These observations demonstrate the expression of SS-R by human granulomas. This scintigraphy procedure may contribute to a more precise staging and evaluation of granulomatous diseases, but more importantly it may be a sensitive indicator of the efficacy of glucocorticoid and/or immunosuppressive therapy.

Topics: Adult; Aged; Aspergillosis; Female; Granulomatosis with Polyangiitis; Humans; Indium Radioisotopes; Lung Diseases, Fungal; Male; Middle Aged; Octreotide; Pentetic Acid; Radionuclide Imaging; Receptors, Somatostatin; Sarcoidosis; Sarcoidosis, Pulmonary; Tuberculosis, Pulmonary