sodium-pertechnetate-tc-99m and Skin-Neoplasms

Accurate staging and early detection of metastases are crucial to melanoma management. It would thus be of great value to have a widely available, cost-effective method that allows to examine the whole body and is more specific than current imaging modalities.. The purpose of the study was to assess the value of immunoscintigraphy with 99mTc-radiolabeled F(ab')2 fragments of the 225.28S monoclonal antibody in the staging of melanoma.. 29 patients with known or suspected metastases were enrolled in the study and examined by monoclonal antibody fragment scintigraphy. The results were compared to physical examination, other imaging modalities and, where available, histology.. Antibody scintigraphy detected 9/34 metastases. There were 2 false-positive lesions. Diagnostic accuracy was 41%, sensitivity 26% and specificity 83%.. 99mTc-radiolabeled F(ab')2 monoclonal antibody-fragment scintigraphy cannot be recommended for staging of melanoma patients. The search for more sensitive radiopharmaceuticals for scintigraphy should thus be encouraged.

Topics: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal; Antibodies, Neoplasm; False Positive Reactions; Female; Humans; Immunoglobulin Fab Fragments; Male; Melanoma; Middle Aged; Neoplasm Metastasis; Predictive Value of Tests; Radioimmunodetection; Sensitivity and Specificity; Skin Neoplasms; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon

A total of 493 melanoma patients were investigated by 20 European nuclear medicine departments by means of the same 99mTc-labelled immunoradiopharmaceutical and the same immunoscintigraphy (ISG) protocol. (i) No chemical or clinical toxicity was detected during or following the studies. (ii) Positive results were obtained in 287/363 (79%) patients (321 carrying known lesions and 42 carrying previously occult lesions): in 231 (80%) of them, 402/402 lesions were imaged; in the remaining 56 ISG-positive patients, 108/204 lesions were imaged; in 76 patients 0/122 lesions were imaged. (iii) The fraction of melanoma lesions visualized by ISG was 510/728 (70.1%); 605 of these lesions were already documented at the time of the study, and 123 were previously occult. (iv) A total of 218 documented melanoma lesions (30%) were not visualized by ISG in 132 patients: about 70% of the ISG-negative lesions were of small size (less than 2 cm diameter). (v) The melanoma nature of 69/123 previously occult lesions was confirmed by clinical criteria and/or additional investigations in follow-up studies. The results obtained in this study are similar to those obtained in the Italian Multicentre Study which had previously been carried out with 258 melanoma patients.

Topics: Antibodies, Monoclonal; Europe; Humans; Immunoglobulin Fab Fragments; Isotope Labeling; Melanoma; Multicenter Studies as Topic; Radionuclide Imaging; Skin Neoplasms; Sodium Pertechnetate Tc 99m

In order to avoid complications after regional chemotherapy (isolated hyperthermic perfusion) of the extremities, rapid measurement of blood leakage from the extracorporeal to the systemic circulation is important. A method using technetium-99m in vivo red blood cell (RBC) labelling is reported that provides results within 3 min. Blood samples drawn from the systemic and the extracorporeal circulation were measured for 99mTc activity using a mobile well counter, and the leakage values calculated. The mean result was 7.6% +/- 6.5%/15 min (n = 209). The corresponding flow rate was 100.2 +/- 85.7 ml/15 min (mean +/- SD). The values for isolation perfusion of the upper and the lower extremities are compared. The leakage results using 99mTc RBC labelling were correlated with other blood pool markers. Iodine-125 human serum albumin and indium-113 m transferrin were administered in subgroups of 4 and 19 patients simultaneously. Using linear regression, the coefficient of correlation was 0.72 for 99mTc/113mIn and 0.58 for 99mTc/125I. Comparison with the alternatives suggests that the rapid method of leakage measurement after 99mTc RBC labelling can be considered one of the most practicable and reliable methods available.

Topics: Chemotherapy, Cancer, Regional Perfusion; Cisplatin; Erythrocytes; Extremities; Female; Humans; Male; Melanoma; Melphalan; Middle Aged; Radionuclide Imaging; Skin Neoplasms; Sodium Pertechnetate Tc 99m; Time Factors

Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Lymphatic Metastasis; Lymphoscintigraphy; Male; Melanoma; Middle Aged; Skin Neoplasms; Sodium Pertechnetate Tc 99m

The possibility of using radiolabelled monoclonal antibody fragments to image uveal melanomas has been assessed in a pilot study. 99mTc labelled F(ab')2 fragments of MoAb 225.28S raised against cutaneous melanomas were used. Initially 10 patients were imaged. In five patients the clinical findings were typical of uveal melanoma. Immunoscintigraphy was positive in all five cases. In a further five patients there was doubt about the diagnosis. One was though to have a choroidal haemangioma but failed to respond to treatment and immunoscintigraphy was positive, suggesting a diagnosis of melanoma. Two patients were assigned a diagnosis of choroidal haemangioma, one of melanocytoma or possible retinal pigment epithelium carcinoma, and one of metastasis. Immunoscintigraphy was negative in all these four cases. In combination with established diagnostic tests immunoscintigraphy may have a part to play in differentiating uveal melanoma from other similar tumours.

Topics: Adult; Aged; Antibodies, Monoclonal; Choroid Neoplasms; Diagnosis, Differential; Female; Hemangioma; Humans; Immunoglobulin Fab Fragments; Male; Melanoma; Middle Aged; Radionuclide Imaging; Skin Neoplasms; Sodium Pertechnetate Tc 99m; Uveal Neoplasms

The clinical picture of ulcerated purple plaques on the legs often suggests several diagnoses: Kaposi's sarcoma, stasis dermatitis, atrophie blanche (livedoid vasculitis), and a poorly understood condition called acroangiodermatitis of Favre-Chaix (pseudo-Kaposi's sarcoma). Even the skin biopsy may not always be conclusive. We describe our experience with three patients with pseudo-Kaposi's sarcoma, one with "true" Kaposi's sarcoma and two with atrophie blanche. Clinical and histopathologic similarities among these three conditions pointed up the need for additional confirmatory studies, i.e., isotope scanning. The technetium scan was positive in both Kaposi's sarcoma and pseudo-Kaposi's sarcoma but negative in atrophie blanche.

Topics: Acrodermatitis; Adult; Aged; Diagnosis, Differential; Female; Humans; Male; Radionuclide Imaging; Sarcoma, Kaposi; Skin; Skin Neoplasms; Sodium Pertechnetate Tc 99m; Syndrome; Technetium; Vascular Diseases; Vasculitis

Scintigraphy with Tc-99m labeled red blood cells (RBCs) was used to evaluate a patient with a large cutaneous hemangioma. The usefulness of this procedure when combined with arteriography is discussed.

Topics: Abdomen; Adult; Angiography; Erythrocytes; Female; Hemangioma; Humans; Radiography, Abdominal; Radionuclide Imaging; Skin Neoplasms; Sodium Pertechnetate Tc 99m; Technetium