technetium-tc-99m-gluceptate and Lung-Neoplasms

Topics: Carcinoma, Bronchogenic; Female; Humans; Lung Neoplasms; Lymphatic Metastasis; Middle Aged; Organotechnetium Compounds; Radiography; Radionuclide Imaging; Sugar Acids; Technetium

Tc-99m sestamibi has been used to detect primary brain and lung tumors. The authors report a patient who underwent brain imaging to differentiate tumor from abscess in the cerebellum because of a ring-like enhancement lesion on a brain CT scan. An abnormal area of increased sestamibi uptake in the right cerebellum was demonstrated planar and on a SPECT imaging. The removed tumor was confirmed to be poorly differentiated metastatic carcinoma.

Topics: Aged; Carcinoma, Bronchogenic; Cerebellar Neoplasms; Humans; Lung Neoplasms; Male; Organotechnetium Compounds; Sugar Acids; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon

A newly developed single photon emission computed tomography (SPECT) method was used to measure noninvasively the concentration of labeled drugs in human lung tumors. The validity of the method was established by the high correlation (r = .92) between in vivo SPECT measurement of the concentration of glucoheptonate labeled with technetium-99m and in vitro measurement of the concentration of the drug in specimens of nine of the same tumors obtained at surgery. The in vivo concentration of intravenously injected bleomycin labeled with cobalt-57 was measured over time in 14 human lung tumors. Significant differences were found in the uptake of bleomycin by the tumors, even those with the same histologic characteristics, when the concentration over time, the tumor/blood ratio at 30 minutes, and the tumor cumulative concentration were measured in vivo. Since the drug concentration in the blood was not related to the concentration in the tumor (r = .54), uptake of chemotherapeutic drugs should be measured in each patient individually.

Topics: Adenocarcinoma; Bleomycin; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Cobalt Radioisotopes; Humans; Lung; Lung Neoplasms; Organotechnetium Compounds; Sugar Acids; Technetium; Time Factors; Tomography, Emission-Computed

Sixty-five patients with suspected or proven pulmonary malignancy were examined with [67Ga]citrate and [99mTc]glucoheptonate ([99mTc]GH) scintigraphy. In the final diagnosis 39 had primary lung carcinoma, four metastases in lung, mediastinum, and pleura from carcinomas elsewhere, and 22 benign pulmonary diseases. The sensitivity in the detection of pulmonary malignancies was 91% with 67Ga and 95% with [99mTc]GH. The intensity of uptake was somewhat greater with 67Ga than with [99mTc]GH in almost all malignant lung tumor groups. The specificity to detect malignant tumors was 82% with both radiopharmaceuticals. Irradiation and chemotherapy seemed to decrease 67Ga uptake but not [99mTc]GH uptake. Only four of 22 benign diseases showed accumulation of both 67Ga and [99mTc]GH. The intensity of uptake in benign processes was almost equal with that in malignant diseases, but most malignant processes were better delineated than the benign lesions. There were many differences between 67Ga and [99mTc]GH uptake, which suggest different mechanisms of accumulation of these agents. It is concluded that some 67Ga studies could be replaced by cheaper and more practical [99mTc]GH.

Topics: Diagnosis, Differential; Gallium Radioisotopes; Humans; Lung Diseases; Lung Neoplasms; Mediastinal Neoplasms; Organotechnetium Compounds; Pleural Neoplasms; Radionuclide Imaging; Sugar Acids; Technetium

Topics: Bronchoscopy; Carcinoma, Bronchogenic; Humans; Lung Neoplasms; Organotechnetium Compounds; Radionuclide Imaging; Sugar Acids; Technetium

Fifty-two patients with proven primary lung cancer who were referred for mediastinoscopy were prospectively studied with Tc-99m glucoheptonate and Ga-67 citrate thoracic scintigraphy. Primary lung tumors concentrated Ga-67 in 92% of cases, compared to 88% for Tc-99m glucoheptonate. Mediastinoscopy confirmed the presence of mediastinal metastases in 23 patients. The sensitivity of Tc-99m glucoheptonate and Ga-67 scans for mediastinal involvement detection is respectively 52% and 83%, for a specificity of 100% (Tc-99m glucoheptonate) and 88% (Ga-67). Twenty-nine patients underwent thoracotomy after a negative mediastinoscopy. Hilar metastatic involvement was present in eight patients. The sensitivity and the specificity for detection of hilar involvement were respectively 63% and 95% for Tc-99m glucoheptonate and 88% and 78% for Ga-67. Although more specific than Ga-67 scan, Tc-99m glucoheptonate thoracic imaging cannot be recommended in the staging of lung cancer because of its low sensitivity in the detection of intrathoracic metastatic spread of primary lung carcinoma.

Topics: Adenocarcinoma; Adult; Aged; Carcinoma; Gallium Radioisotopes; Humans; Lung Neoplasms; Lymphatic Metastasis; Mediastinal Neoplasms; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sugar Acids; Technetium; Thorax

A case of a squamous cell lung carcinoma detected with 99mTc-DPD, 67Ga-citrate and 99mTc-glucoheptonate (GH) is reported. The highest uptake was seen with DPD and the lowest with 67Ga. Emission-computed tomography was very useful in DPD imaging but gave less new information in GH and 67Ga studies in comparison to traditional planar imaging. The patient had been given both irradiation and chemotherapy, which might be the cause of good accumulation of DPD and rather poor accumulation of GH and 67Ga.

Topics: Carcinoma, Squamous Cell; Diphosphonates; Gallium Radioisotopes; Humans; Lung Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Sugar Acids; Technetium; Tomography, Emission-Computed

It has been shown by Vorne et al. and Passamonte et al. that technetium-99m-glucoheptonate (Tc-GH) concentrates in bronchial carcinomas. The two studies reported similar sensitivities (88 and 91%, respectively) but discordant specificities (88 and 10%, respectively). In order to assess the uptake of Tc-GH in bronchial carcinomas we performed lung imaging on patients with an abnormal chest radiograph who were undergoing routine investigations for bronchial carcinoma. 108 patients (85 carcinoma, 23 non-carcinoma) were given 555 MBq (15 mCi) Tc-GH intravenously and scanned 5 h later. Images were assessed by one investigator (J.A.L.) without knowledge of the patient's clinical details or other results. Localized uptake of Tc-GH was seen in 71 out of 85 patients who proved to have bronchial carcinoma. Uptake was also seen in 16 out of 23 patients with a variety of non-malignant lung conditions. Sensitivity for bronchial carcinoma was 84%, and specificity 30%. Uptake did not vary significantly with histology. Eleven out of 12 patients with proven tuberculosis had increased uptake of Tc-GH; two of those patients also had inactive lesions which did not concentrate the tracer. In conclusion, Tc-GH is of limited value in the diagnosis of bronchial carcinoma, because of its low specificity. A possible role in the diagnosis of active tuberculosis may exist, following further assessment.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Bronchogenic; Female; Humans; Lung; Lung Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sugar Acids; Technetium

Technetium-99m glucoheptonate (Tc-99m GH) is concentrated in pulmonary and cerebral tumors. The purpose of this study was to assess the uptake of this radionuclide by hepatocellular carcinoma. Its concentration by the primary tumor was compared with that in the non-neoplastic hepatic tissue in 31 patients who showed obvious defects on a colloid scan, and its uptake by pulmonary metastases was examined in six patients with x-ray evidence of this complication. In two patients, the uptake by the tumor was greater than, in six it was equal to, and in ten it was less than that in the non-neoplastic hepatic tissue. In the remaining 13 patients, there was no concentration at all in the tumor. In none of the six patients with multiple pulmonary metastases could uptake of Tc-99m GH by the metastases be demonstrated. It is concluded that Tc-99m GH is of limited value in the diagnosis of primary or metastatic hepatocellular carcinoma.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Female; Humans; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sugar Acids; Technetium; Technetium Compounds; Tin; Tin Compounds

Neurologic history and examination, radionuclide brain scans (RN), and computed tomographic brain scans (CT) were performed at diagnosis and sequentially in 153 consecutive patients with small cell lung cancer (SCLC) to assess the sensitivity and accuracy of these screening methods and to determine whether the early detection of brain metastases influences survival. CT scans (sensitivity, 98%; positive predictive accuracy, 98%) were superior to RN scans (sensitivity, 71%; positive predictive accuracy, 86%) in patients with or without neurologic signs or symptoms. However, CT scans were positive in only 6% of asymptomatic patients at diagnosis and 13% of asymptomatic patients after systemic therapy. Brain metastases detected by CT scan were the sole site of extensive-stage disease in 6% of patients at diagnosis. Despite the enhanced ability of CT scans to detect asymptomatic lesions, survival after therapeutic cranial irradiation was similar for asymptomatic and symptomatic patients. The results suggest that CT brain scans should be used routinely in SCLC patients with neurologic signs or symptoms, at diagnosis (when treatment decisions are based on stage), and at six-month intervals in patients with prior brain metastases and in whom erratic follow-up is likely.

Topics: Actuarial Analysis; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Carcinoma, Small Cell; Diagnostic Errors; Female; Follow-Up Studies; Humans; Lung Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sugar Acids; Technetium; Tomography, X-Ray Computed

We prospectively studied technetium-99m glucoheptonate (Tc-GHA) uptake in 58 patients with newly diagnosed lung cancer and in 20 patients with pulmonary inflammatory disease or metastatic carcinoma. Fifty-three (91%) primary tumors accumulated Tc-GHA: squamous cell 20/22, adenocarcinoma 7/7, large cell 10/11, and small cell 16/18. Intensity of tumor uptake was greatest in small-cell cancer. Supraclavicular metastases were detected in two patients. Fourteen patients with mediastinal evaluation by Tc-GHA imaging and trispiral tomography underwent mediastinoscopy or thoracotomy. Five of ten patients with negative mediastinum by tomography and Tc-GHA imaging showed metastases by biopsy (false-negative Tc-GHA). Less intense accumulation of Tc-GHA was observed in 18/20 cases of pulmonary inflammatory disease or pulmonary metastases. Although Tc-GHA accumulates by an unknown mechanism in primary lung cancer, we cannot recommend its use in detecting mediastinal spread of lung cancer due to its unacceptably high false-negative rate.

Topics: Adenocarcinoma; Carcinoma, Bronchogenic; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Histoplasmosis; Humans; Lung Diseases; Lung Neoplasms; Mediastinal Neoplasms; Organotechnetium Compounds; Radionuclide Imaging; Sugar Acids; Technetium

Sixty-three patients aged 21-80 yr were examined. Tc-99m glucoheptonate (Tc-GH) scintigraphy was performed in 32 patients: 26 with primary lung carcinoma; six with metastases in lung, mediastinum, and pleura from carcinomas elsewhere; eight with benign pulmonary diseases; and 23 without known pulmonary disease. Tc-GH accumulated in 23 of 26 primary pulmonary carcinomas as active foci. The specificity of Tc-GH scans for neoplasm detection was higher than that of chest radiographs. The visualization of malignant tumors was much better in the late Tc-GH images (5-6 hr) than in the early (1 hr). Metastases from other carcinomas were positive in four of six patients, but they were considerably better detected in the radiographs, except in one patient with metastatic hepatocellular carcinoma. Neoplasms or their metastases in the hilar and mediastinal regions were better detected in the Tc-GH scans than in the chest radiographs. Only one of eight benign lung processes was visualized (as a weak diffuse accumulation of Tc-GH in hilar scar formation), and 23 patients without pulmonary disease had no pathological foci.

Topics: Adenocarcinoma; Adult; Aged; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Humans; Lung Diseases; Lung Neoplasms; Mediastinal Neoplasms; Middle Aged; Organotechnetium Compounds; Pleural Neoplasms; Radionuclide Imaging; Sugar Acids; Technetium