technetium-tc-99m-sulfur-colloid and Colonic-Neoplasms

Although the utility of lymphatic mapping (LM) and sentinel lymph node (SLN) biopsy in patients with melanoma and breast carcinoma has been well documented, this same is not true for patients with colon carcinoma. The authors previously reported a high false-negative rate for SLN biopsy in patients with colon carcinoma using isosulfan blue dye alone. The objective of the current study was to determine whether radiocolloid would increase the sensitivity of LM/SLN biopsy in patients with colon carcinoma.. The authors performed LM on 57 patients with colon carcinoma using both isosulfan blue dye and radiocolloid. The SLN(s) were identified by either their blue color or by increased radioactivity. The SLNs then underwent both routine histologic sectioning and immunohistochemical (IHC) staining for cytokeratins.. An SLN was identified in 56 patients (98%). Radiocolloid was able to identify only 1 additional positive SLN (9%). Overall, it was found that the disease had metastasized to the lymph nodes in 22 patients, even though there was no evidence of disease in the SLN(s) in 11 of those 22 patients on routine histologic sectioning (false-negative rate, 50%; sensitivity, 50%). In five patients, IHC of the SLN was the only indicator of metastatic disease. The inclusion of IHC-positive SLNs in these calculations would decrease the false-negative rate to 17% and would increase the sensitivity of SLN biopsy to 83%.. In the current study, the addition of radiocolloid did not increase the sensitivity of detection of positive SLN(s) compared with the use of isosulfan blue dye alone. IHC of the SLN potentially may increase the sensitivity of LM and reduce the false-negative rate. However, the long-term prognostic significance of IHC in patients with colon carcinoma remains controversial.

Topics: Adult; Aged; Aged, 80 and over; Colonic Neoplasms; Female; Humans; Immunoenzyme Techniques; Keratins; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Prognosis; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Rosaniline Dyes; Sensitivity and Specificity; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

Current conventional surgical and pathological techniques substantially understage colon cancer. This is evidenced by the fact that a significant subset of patients who are stage I and II at the time of colectomy return with distant metastases and ultimately succumb to the disease within the next 5 years. The identification of more nodes within a specimen and the detailed analysis of lymph nodes with advanced pathological techniques such as immunohistochemistry and reverse-transcriptase polymerase chain reaction (RT-PCR) can improve the staging of colon cancer, but are also associated with tremendous financial, time, and labor constraints. Sentinel lymph node (SLN) mapping has provided an avenue of staging colon cancer with high success rates and accuracy rates, while maintaining cost- and time-effectiveness. The ability to reproduce these results is dependent on adherence to the technical details of the procedure, and thereby providing the pathologist with the true SLNs, upon which the advanced pathological studies can be applied. We report our experience of SLN mapping for colon tumors in 209 patients, elaborating on the materials used, technical details, pitfalls, and results of the procedure. Our results show a success rate of 100% (209/209) and an overall accuracy rate for predicting positive or negative metastatic disease of 96.2% (201/209). Nodal metastases were identified in 46.2% (85/184) of patients with invasive disease (stage T1 to T4). The SLN was the exclusive site of metastases in 38.8% (33/85) of these patients, and the nodal disease was detected only as micrometastases in 22.4% (19/85). The skip metastases rate (false negatives) was 9.4% (8/85). SLN mapping is a powerful tool for accurate staging of colon cancer with a high success rate. The upstaging associated with this procedure may reveal disease that might otherwise go undetected by conventional surgical and pathological methods. Those patients who are upstaged can then benefit from adjuvant chemotherapy, which has been shown to improve survival of colon cancer patients with nodal disease by at least 33%.

Topics: Colonic Neoplasms; Coloring Agents; Fluorescein; Humans; Lymphatic Metastasis; Neoplasm Staging; Radiopharmaceuticals; Rosaniline Dyes; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

Detection of gastrointestinal bleeding by means of radiotracers is a non-invasive method, and should be considered when endoscopy and barium radiography have failed to identify the focus. The two most prominent tracers are 99mTc sulphur colloid and 99mTc red blood cells, and both detect lower gastrointestinal bleeding with at least the same sensitivity as angiography. A case of gastrointestinal bleeding in a 68-year old woman is presented. The bleeding source in the colon was precisely identified with the 99mTc RBC method, and was later shown to be a metastasis from her endometrial cancer.

Topics: Aged; Colonic Neoplasms; Endometrial Neoplasms; Female; Gastrointestinal Hemorrhage; Humans; Radionuclide Imaging; Technetium; Technetium Tc 99m Sulfur Colloid

Seventeen single-photon emission CT (SPECT) studies were performed after intraperitoneal administration of 99mTc-sulfur colloid in patients with a history of colon cancer to assess the extent of intraperitoneal fluid distribution prior to intraperitoneal chemotherapy. Planar gamma images were also obtained in all patients for correlation with the SPECT findings. Four patients had transmission CT scans of the abdomen after intraperitoneal administration of iodinated contrast material. In seven patients, repeat planar and SPECT studies were performed with the original or a different infusion volume to determine if different volumes altered the fluid distribution qualitatively or quantitatively (using a linear profile method). We found that 360 degrees peritoneal SPECT is easily performed after intraperitoneal administration of 99mTc-sulfur colloid. SPECT provides more detailed anatomic information than planar scans do. Spaces of the upper abdomen, such as the lesser sac, were resolved better with SPECT than with planar imaging. SPECT assessment of intraperitoneal fluid distribution also correlated well with transmission CT scans. Quantitative linear-profile radionuclide plots were reproducible at the same volume and showed no major differences in relative intraperitoneal fluid distribution between the 1.5- and 3.0-l infusion volumes, suggesting that the two delivery volumes were equivalent in relative distribution. SPECT appears to be a useful procedure to define the extent and location of intraperitoneally administered fluids. Thus, it may be of value in determining the intraperitoneal distribution of drugs and radiopharmaceuticals used in the treatment of intraabdominal tumors.

Topics: Adult; Aged; Ascitic Fluid; Colonic Neoplasms; Humans; Male; Middle Aged; Radiographic Image Enhancement; Technetium Tc 99m Sulfur Colloid; Tissue Distribution; Tomography, Emission-Computed; Tomography, X-Ray Computed

Isotope liver scanning is an accurate technique for detecting liver metastases from large bowel cancer. In this retrospective study of patients who had a resection for bowel cancer, the accuracy of liver scanning was 95%. However, the scan accuracy as defined by median survival time was insufficient to detect liver metastases missed by the surgeon at operation and did not alter the clinicopathological stage of the patient's disease.

Topics: Actuarial Analysis; Aged; Colonic Neoplasms; Female; Humans; Liver Neoplasms; Male; Neoplasm Staging; Predictive Value of Tests; Radionuclide Imaging; Rectal Neoplasms; Retrospective Studies; Technetium Tc 99m Sulfur Colloid

The importance of portal circulation in the delivery of drugs and nutrients to colorectal hepatic metastases is controversial. Using 13N (nitrogen 13) amino acids and ammonia with dynamic gamma camera imaging, we demonstrate, for the first time in human beings, a quantitative advantage of hepatic artery compared with portal vein infusion. Eleven patients were studied by hepatic artery injection, five patients were studied by portal vein injection, and two patients had injections through both routes. Data collected from the liver for 10 minutes after rapid bolus injection of 13N L-glutamate, L-glutamine, or ammonia were compared with 99mTc (technetium) macroaggregated albumin (MAA) images produced after injection through the hepatic artery or portal vein at the same session. Tumor regions defined from 99mTc sulfur colloid scans were compared with nearby liver areas of similar thickness. For the 13N compounds, the area-normalized count rate at first pass maximum (Qmax) and the tissue extraction efficiency were computed. The tumor/liver Qmax ratios for MAA and 13N compounds were highly correlated. Both tumor and liver extracted more than 70% of the nitrogenous compounds. The tumor/liver Qmax ratios reflect the relative delivery of injected tracer per unit volume of tissue. After hepatic artery injection the Qmax ratio was 1.03 +/- 0.33 (mean +/- SD), significantly exceeding the Qmax ratio of 0.50 +/- 0.34 after portal vein injection (P less than 0.003). Therefore, more than twice as much of a nutrient substrate is delivered per volume of tumor relative to liver by the hepatic artery as by the portal vein; the high extraction efficiency demonstrates that the hepatic artery flow is nutritive; and the delivery of substance in solution (such as nutrients or drugs) to tumor and liver tissue correlates with the distribution of colloids such as macroaggregated albumin after hepatic arterial and portal venous injection.

Topics: Adult; Aged; Colonic Neoplasms; Female; Glutamine; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Rectal Neoplasms; Regional Blood Flow; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid

Fifty-five consecutive patients with colorectal carcinoma and hepatic metastases on the Tc-99m sulfur colloid liver/spleen scan (TSC) were evaluated to see if the pattern of spread of colorectal metastases was affected by the venous drainage of the primary site. The results suggest that significant streaming probably exists in the portal vein and the spread of metastases to the liver is affected by it. This information has a potential clinical implication in terms of diagnostic workup and chemotherapeutic infusions. It also supports the speculation that a streaming effect exists in humans.

Topics: Aged; Colonic Neoplasms; Female; Humans; Liver Circulation; Liver Neoplasms; Male; Middle Aged; Portal Vein; Radionuclide Imaging; Rectal Neoplasms; Technetium Tc 99m Sulfur Colloid

Radionuclide peritoneoscintigraphy has been used prior to chromic phosphate P-32 (P-32CP) intraperitoneal therapy to assure proper placement of the catheter in the peritoneal cavity, to exclude loculation, and to predict inadequate distribution of P-32CP. This is a case report of the detection of a peritoneal catheter improperly placed into the bowel lumen by pretherapy radionuclide peritoneoscintigraphy, and this case demonstrates the distinguishing characteristics of the radiocolloid distribution secondary to an intraluminal injection relative to an intraperitoneal injection.

Topics: Adenocarcinoma; Brachytherapy; Catheterization; Chromium; Chromium Compounds; Colonic Neoplasms; Female; Humans; Middle Aged; Peritoneal Cavity; Peritoneal Neoplasms; Phosphates; Phosphorus Radioisotopes; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Single photon emission computerized tomography coupled with Tc-99m MAA hepatic-arterial perfusion scintigraphy has been used to examine the density of the functional microcirculation of hepatic tumors relative to normal liver in 24 patients. In both colorectal and carcinoid tumors we have demonstrated an average three-fold greater arteriolar-capillary density in areas of tumor proliferation. The depth of the evoked tumor hypervascularity was found to extend about 4 cm. Tumors greater than 8-9 cm in diameter were uniformly found to have a central hypovascular core. These observations are of importance in the design of selective strategies utilizing therapeutic microspheres directed against the hypervascular proliferating regions of human tumors.

Topics: Adult; Aged; Biopsy; Carcinoid Tumor; Carcinoma, Hepatocellular; Colonic Neoplasms; Female; Humans; Liver Neoplasms; Male; Microcirculation; Middle Aged; Particle Size; Serum Albumin; Sulfur; Technetium; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

Topics: Adult; Carcinoma; Colloids; Colonic Neoplasms; Diphosphonates; Female; Humans; Liver Neoplasms; Sulfur; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

Correlation of a chest roentgenogram and a radionuclide scan facilitated the interpretation of a liver scan with a defect in the dome that was due to an extrinsic compression and photon attenuation by a metastatic tumor in the right lung base.

Topics: Adenocarcinoma; Aged; Colonic Neoplasms; False Positive Reactions; Humans; Liver; Lung Neoplasms; Radiography; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

A prospective evaluation of computed tomography (CT), ultrasonography (US), and Tc-99m sulfur colloid scintigraphy of the liver was performed in 189 patients who had either colon (n = 129) or breast (n = 60) carcinoma. Imaging was performed with fourth-generation CT scanners, gray-scale or phased array ultrasound scanners, and 37-tube gamma cameras. Studies were evaluated independently and receiver operating characteristic (ROC) curves were constructed. In addition, a standard 2 X 2 matrix analysis was performed. In patients who had all three examinations (n = 122), the matrix analysis showed that CT had a slightly higher sensitivity (0.93) than scintigraphy (0.86) or US (0.82); specificities were 0.88, 0.83, and 0.85, respectively. These differences were not statistically significant. However, ROC curves showed that CT had the highest true-positive ratio at every false-positive ratio, and that US had the lowest. The performance of CT did not differ significantly from that of scintigraphy, but was better than that of US (p less than .05), especially in patients with breast carcinoma. Overall, CT provided the most accurate means for detecting liver metastases from both primary lesions.

Topics: Breast Neoplasms; Carcinoma; Colloids; Colonic Neoplasms; Diatrizoate; Diatrizoate Meglumine; False Positive Reactions; Female; Humans; Liver; Liver Neoplasms; Male; Prospective Studies; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

Nine patients with colonic carcinoma were studied with I-131-labeled F(ab')2 fragments of an anti-colorectal carcinoma monoclonal antibody. A total of 69% of colon cancer sites were detected without background subtraction; metastases from a concurrent breast carcinoma in one patient were not seen. Lesions ranged from 1.5 to 8 cm. The mean thyroid uptake of I-131 at 24 hours was 0.25%. Half-lives of I-131 in the blood (protein-bound and total) fit a two-compartment model, with half-lives of 3.5 and 27.6 hours for the protein-bound fraction and 3.6 and 23.8 hours for total I-131. Using quantitative methods, a mean value of 0.0047%/cm3 of the administered dose was localized in the tumor at peak concentration, which occurred approximately 48 hours post-administration. This has implications for therapy planning.

Topics: Antibodies, Monoclonal; Carcinoma; Colonic Neoplasms; Erythrocytes; Humans; Immunoglobulin Fab Fragments; Iodine Radioisotopes; Liver Neoplasms; Lung Neoplasms; Radionuclide Imaging; Retroperitoneal Neoplasms; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

99mTc sulfur colloid scintigraphy is a technique which can be used to localize sites of lower gastrointestinal hemorrhage. Two reports of patients illustrate its use clinically. This procedure is non-invasive, relatively inexpensive, easily performed and has a high degree of sensitivity. The technique may, in some instances, replace angiography or endoscopy as the initial procedure used to diagnose the site of lower gastrointestinal bleeding or, more likely, serve as a complementary diagnostic modality.

Topics: Aged; Arteriovenous Malformations; Colloids; Colonic Neoplasms; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Ileum; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Metastatic involvement of the spleen is uncommon. Lymphoma is the most common cause of primary and secondary malignant lesions of the spleen, whereas splenic metastases from carcinoma are rare and usually occur in a setting of concomitant carcinomatosis with melanoma, breast, ovary and lung accounting for the principal primary tumors. We report a case of an isolated, focal splenic defect demonstrated by Tc-99m-sulfur colloid scintigraphy which was the only visual evidence of metastatic adenocarcinoma of the colon. To our knowledge this unusual cause of a focal splenic defect on liver-spleen scintigraphy has not been previously described.

Topics: Adenocarcinoma; Aged; Colonic Neoplasms; Humans; Liver; Male; Radionuclide Imaging; Spleen; Splenic Neoplasms; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Hepatic scintigraphy was performed prior to surgical exploration in 89 patients with primary carcinoma of the large bowel. Of these patients, 26% had positive liver scans at the time the diagnosis was established. The presence or absence of liver metastasis by scintigraphic criteria was correlated with surgical findings, a modified Duke pathologic classification, and the presence of tumor markers. The sensitivity of hepatic scintigraphy was 96% and the specificity was 98%. A total of 63% of patients with abdominal lymph node involvement had positive liver scans while 4.6% of patients without lymph node involvement had positive scans. A total of 91% of patients with positive liver scans had positive abdominal nodes. Of 60 patients with normal liver scans, one (1.7%) had hepatic metastasis and 27% had tumor in regional lymph nodes. Hepatic scintigraphy is highly sensitive in detecting liver metastasis from large bowel carcinoma. However, a negative liver scan did not exclude abdominal lymph node spread.

Topics: Adult; Aged; Carcinoma; Colonic Neoplasms; Female; Humans; Liver; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Aged; Cholestasis, Extrahepatic; Colonic Neoplasms; False Positive Reactions; Female; Gallbladder Neoplasms; Humans; Imino Acids; Liver Neoplasms; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Lidofenin; Technetium Tc 99m Sulfur Colloid