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

Topics: Antimony; Ascites; Breast Neoplasms; Colloids; Female; Gastrointestinal Neoplasms; Gold Colloid, Radioactive; Humans; Indium; Lung Neoplasms; Lymphoscintigraphy; Male; Melanoma; Mercury Radioisotopes; Methods; Neoplasm Staging; Organotechnetium Compounds; Ovarian Neoplasms; Phytic Acid; Prostatic Neoplasms; Radioisotopes; Sulfur; Technetium; Technetium Compounds; Technetium Tc 99m Sulfur Colloid

Mediastinal lymph node involvement can be understaged in cases of lung cancer (up to 20% in stage i). Sentinel node detection is a standard technique recommended in breast cancer and melanoma action guidelines, and could also be useful in cases of lung cancer.. Considering the detection of the sentinel node in non-small cell lung cancer (NSCLC) as feasible, a prospective cohort study was carried out on 48 patients with resectable NSCLC, using the intraoperative injection of colloid sulphate technetium-99.. The radioisotope migrated in all cases. The procedure's sensitivity was 88.24%, its accuracy was 95.83%, its negative predictive value was 93.94% and the false negative rate was 11.76%. No complications were associated with this technique.. The detection of a sentinel node in NSCLC with the intraoperative injection of the isotope is feasible and safe, and allows for detection and sensitivity rates comparable to those of other tumour types.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Female; Humans; Intraoperative Care; Lung Neoplasms; Lymphatic Metastasis; Male; Mediastinum; Middle Aged; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

Sentinel node mapping with radioactive technetium in non-small cell lung cancer has been shown to be feasible in several single institution reports. The Cancer and Leukemia Group B designed a phase II trial to test a standardized method of this technique in a multi-institutional setting. If validated, the technique could provide a more accurate and sensitive way to identify lymph node metastases.. Patients with clinical stage I non-small cell lung cancer amenable to resection were candidates for this trial. Intraoperatively, tumors were injected with technetium sulfur colloid (0.25 mCi). The tumor and lymph nodes were measured in vivo with a hand held Geiger counter and resection of the tumor and nodes was carried out. Sentinel nodes, all other nodes and the tumor were analyzed with standard histologic assessment. Negative sentinel nodes were also evaluated with immunohistochemistry.. In this phase II trial, 8 surgeons participated (1-13 patients enrolled per surgeon), and 46 patients (out of a planned 150) were enrolled. Of these, 43 patients had cancer and an attempted complete resection, and 39 patients underwent sentinel node mapping. One or more sentinel nodes were identified in 24 of the 39 patients (61.5%). The sentinel node(s) were found to be accurate (no other nodes were positive for cancer if the sentinel node was negative) in 20/24 patients (83.3%). In the overall group the sentinel node mapping procedure was found to be accurate in 20/39 patients (51.2%).. Intraoperative sentinel node mapping in lung cancer with radioisotope yielded lower accrual and worse accuracy than expected. The multi-institutional attempt at validating this technique was unsuccessful.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Carcinoma, Large Cell; Carcinoma, Non-Small-Cell Lung; Carcinoma, Squamous Cell; Feasibility Studies; Female; Humans; Lung Neoplasms; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Monitoring, Intraoperative; Neoplasm Staging; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Risk Factors; Sentinel Lymph Node Biopsy; Survival Rate; Technetium Tc 99m Sulfur Colloid; Treatment Outcome

Sentinel lymph node identification has been tested in lung cancer patients with conflicting results. The present study was designed to assess the sensitivity, negative predictive value, and accuracy of intraoperative sentinel lymph node mapping by means of a radio-guided method in patients with nonsmall cell lung cancer to find the most appropriate definition of sentinel lymph node and to evaluate the usefulness of different particle sizes of radiocolloid.. One hundred ten patients with clinically N0 nonsmall cell lung cancer were enrolled in the pilot study of intraoperative sentinel node identification. Four quadrants of the peritumoral tissue were injected with 2 mL of 0.5 mCi technetium-99m suspension. Four radiocolloids of different particle size were used. After complete lymphadenectomy, all resected lymph nodes were examined with hematoxylin-eosin staining. All sentinel nodes negative for metastases by routine staining were searched further for metastatic deposits with both serial sections and immunohistochemistry for cytokeratins.. The radio-guided method had a high identification rate, a high sensitivity, and a high negative predictive value (100%, 87%, and 93%, respectively) when immunohistochemistry was considered. When standard hematoxylin and eosin staining was applied, sensitivity and negative predictive value of sentinel lymph node labeling was lower (74% and 89%, respectively). No significant differences were found in either the sensitivity or negative predictive value among the colloid solutions of different particle size used in radio labeling, although smaller particles have shown a tendency to produce better results.. The radio-guided technique provides efficient sentinel lymph node identification in lung cancer. Further studies are warranted to confirm the clinical utility of this strategy.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Carcinoma, Non-Small-Cell Lung; Decision Making; Female; Humans; Intraoperative Care; Keratins; Lung Neoplasms; Lymphatic Metastasis; Male; Mediastinum; Middle Aged; Neoplasm Proteins; Neoplasm Staging; Particle Size; Pilot Projects; Pneumonectomy; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Sentinel Lymph Node Biopsy; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid

Lymph node metastases are significant prognostic factors in localized non-small-cell lung cancer (NSCLC). Nodal micrometastases may not be detected using current histological methods.. To determine the accuracy and role of sentinel lymph nodes (SLNs) in patients with NSCLC.. Intraoperative technetium-99m (Tc) sulphur colloid SLN mapping was performed in patients with NSCLC. Serial section histology and immunohistochemistry were used to validate the SLNs and to identify the presence of micrometastatic disease. The study was carried out on 28 consecutive patients (male/female, 25/3; mean age, 57.05+/-7.1 years) with resectable NSCLC. During thoracotomy, 0.25 mCi of Tc sulphur colloid was injected into four quadrants peritumorally. Radioactivity was counted intraoperatively, a mean of 45 min (range, 30-60 min) after injection. SLN was defined as the node with the highest count rate using a hand-held gamma probe counter. Resection with mediastinal node dissection was performed and the findings were correlated with histological examination.. SLNs were identified in 26 of 28 patients (92.8%) with a total number of 32 SLNs. Seven of 32 (21.8%) of these SLNs were positive for metastatic involvement after histological and immunohistochemical examination. In two patients (7.1%), SLNs could not be found.. These results demonstrate the feasibility of this procedure in identifying the first site of potential nodal metastasis of NSCLC. This method may improve the precision of pathological staging.

Topics: Carcinoma, Non-Small-Cell Lung; Feasibility Studies; Female; Humans; Intraoperative Care; Lung Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Mediastinum; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

After significant trauma to the spleen, small viable splenic fragments may exist in the peritoneal cavity or, less commonly, in the thorax. Thus, the appearance of splenules within the thorax on CT images can easily be mistaken for malignancy and lead to unnecessary intervention. Here, we present a case of multiple pulmonary masses that initially were presumed to be malignancy, leading to CT-guided biopsy, but were eventually confirmed to be thoracic splenules through

Topics: Diagnosis, Differential; Female; Humans; Image-Guided Biopsy; Lung Neoplasms; Middle Aged; Technetium Tc 99m Sulfur Colloid; Thoracic Injuries; Tomography, X-Ray Computed

Aim of the study was to observe the impact of bone marrow damage induced by local irradiation on leukopenia.. For the human study, five cancer patients received local radiation therapy. Bone marrow aspiration was conducted to measure nucleated cell count and 99mTc-Sc sulfur colloid ECT imaging was carried out to examine bone marrow function. For the animal study, fifty New Zealand white rabbits were divided into 3 groups: non-irradiated control group (N.=10), abdomen irradiation group (irradiation area did not cover bone marrow) (N.=20), chest irradiation group (irradiation area covered bone marrow) (N.=20). Nucleated cell counts were taken after confirming onset of leukopenia.. Bone marrow of five patients proliferated normally. ECT imaging showed no abnormality in the pattern of red bone marrow distribution. Hematopoietic function was mildly active.. Suppressed myeloproliferative function does not fully account for irradiation-induced leukopenia.

Topics: Animals; Bone Marrow; Bone Marrow Cells; Cell Proliferation; Esophageal Neoplasms; Female; Hodgkin Disease; Humans; Leukocytes; Leukopenia; Lung Neoplasms; Male; Nasopharyngeal Neoplasms; Rabbits; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

The prognosis of dogs with primary lung tumors and lymph node metastasis is poorer than of dogs without metastasis. Biopsy of intrathoracic lymph nodes is recommended, but without specific guidelines. This study investigated incorporation of a human lymph node classification in normal dogs with intercostal thoracotomies. Methylene blue and technetium-99m sulfur colloid lobar injections were used for enhanced nodal identification. Descriptive comparisons were made for lymph node resections utilizing both veterinary and human anatomic lymph node charts. Amedian of 2 (range 1–4) lymph nodes were removed per hemithorax in vivo versus a median 6.5 (range 2–8) lymph nodes removed ex vivo from each hemithorax following in vivo dissections. Incorporation of a human thoracic lymph node classification system may be useful for future clinical application in dogs. Future use of either methylene blue or technetium for canine thoracic lymphadenectomy needs to be evaluated further.

Topics: Animals; Dogs; Humans; Injections; Lung Neoplasms; Lymph Nodes; Lymphatic Metastasis; Methylene Blue; Radionuclide Imaging; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

The widespread use of computed tomography (CT) scans for evaluating patients has resulted in the detection of many small solitary pulmonary nodules of uncertain significance. Workup of these nodules can be expensive and emotionally draining, especially in patients who have an established diagnosis of malignancy. Since the early 1990s, video-assisted thoracoscopic surgery (VATS) has become a procedure of choice in the workup and therapy of small lung lesions. Many different techniques have been described that would assist surgeons in localising small non-descript lesions in the lung during VATS. Most commonly, a single agent or mechanical device has been used for tumour localisation. We have modified the existing pre-VATS localisation techniques, evolving from one single agent with single spot injection to a dual-agent approach. In this approach, each agent is injected at two different locations. This technique provides us with a more precise 'linear projection' to the lesion of interest rather than the vague 'field localisation' provided by a single agent with a single spot injection. This modified dual agent's preoperative localisation is logical, practical and easy to be adopted into the clinical setting for surgeons who choose to use the VATS technique in addressing these lung nodules.

Topics: Aged; Female; Humans; Lung Neoplasms; Methylene Blue; Radiopharmaceuticals; Solitary Pulmonary Nodule; Technetium Tc 99m Sulfur Colloid; Thoracic Surgery, Video-Assisted

The objective of this study was to evaluate the feasibility of the sentinel lymph node (SLN) biopsy in peripheral clinically stage I or II non-small cell lung cancer (NSCLC) using (99m)Tc colloid and a hand-held gamma detection probe, associated with a blue dye technique.. Prospective study.. Royal Brompton Hospital, London, UK; and Hopital Nord, Saint Etienne, France.. After thoracotomy, a total of 2 mL patent blue dye mixed with 1,600 muCi (99m)Tc-albumin or (99m)Tc-colloid was injected into each quadrant of lung tissue immediately surrounding the tumor. Routine lymphadenectomy was carried out. The first lymph nodes to stain blue or radioactive, if any, were considered SLNs.. Twenty-four patients were evaluated. We successfully identified 17 SLNs in 13 patients (detection rate, 54.2%). Mean time from injection to identification of SLNs was 18 min (range, 5 to 30 min). In nine cases, the SLN was blue and radioactive, in six cases only blue, and in two cases only radioactive. The pathologic status of the SLN reflected the pathologic status of other nodes of the routine lymphadenectomy except one case of false-negative SLN (14%). Four SLNs were in N2 stations (23.5%).. The sentinel node mapping in NSCLC with blue dye and radioisotopic techniques is feasible, but the detection rate has to be improved. This technique is an accurate method of identifying the first node draining a tumor, although it is not yet sufficiently sensitive to have a role in reducing the extent of nodal dissection.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Feasibility Studies; Female; Gamma Cameras; Humans; Lung Neoplasms; Lymph Node Excision; Lymph Nodes; Male; Middle Aged; Neoplasm Staging; Prospective Studies; Radionuclide Imaging; Rosaniline Dyes; Sensitivity and Specificity; Sentinel Lymph Node Biopsy; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid

Lymph node metastases are the most significant prognostic factor in localized non-small-cell lung cancer (NSCLC). Nodal micrometastases may not be detected with current standard histologic methods. We review our experience with intraoperative injection of radioisotope, the current state of the technique, and the experience of other groups with alternate methods and tracers.

Topics: Adenocarcinoma; Carcinoma, Non-Small-Cell Lung; Humans; Intraoperative Period; Lung Neoplasms; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

The purpose of this study was to develop and evaluate radiotracer-guided localization of small or ill-defined pulmonary nodules for thoracoscopic excisional biopsy.. This study consisted of two parts: a laboratory study in rats to determine the most suitable radiotracer, and a pilot study in humans to determine the feasibility of radiotracer lung nodule localization. The right lung of 12 rats was injected with a technetium 99m (Tc 99m) based radiotracer solution: 4 each with macroaggregated albumin (MAA), unfiltered sulfur colloid (SC), and pertechnetate (TcO(4)). Serial imaging was performed using a small animal gamma camera for 4 hours following injection. In 13 patients, computed tomographic (CT) guided injection of Tc 99m MAA solution was made into or adjacent to a pulmonary nodule suspicious for primary lung cancer. Gamma probe localization of the nodule was performed during subsequent thoracoscopic surgery.. In the animal model, MAA provided more precise localization than SC or TcO(4) and was selected for the human study. In the human series, all 13 patients had successful gamma probe localization of their lesion. There were no radiologic or surgical complications. Seven of 13 nodules were malignant, and five of these nodules were stage IA primary lung carcinomas.. Computed tomographic-guided radiotracer localization of small or ill-defined pulmonary nodules using Tc 99 m MAA before thoracoscopic excisional biopsy is feasible and may make excisional biopsy the preferred management strategy for the management of small pulmonary nodules in patients at high risk for malignancy.

Topics: Aged; Albumins; Animals; Feasibility Studies; Female; Humans; Lung Neoplasms; Male; Middle Aged; Pilot Projects; Radionuclide Imaging; Radiopharmaceuticals; Rats; Rats, Sprague-Dawley; Sodium Pertechnetate Tc 99m; Solitary Pulmonary Nodule; Technetium; Technetium Tc 99m Sulfur Colloid; Thoracoscopy

Application of the sentinel node concept to lung cancer is still controversial. Patients with peripheral small lung cancers would gain the most benefit from this concept, if it were valid. We sought to determine whether it is possible to choose between limited lymph node sampling and systematic lymphadenectomy from the distribution of sentinel lymph nodes in patients with node-negative disease on the basis of imaging.. Sixty-five consecutive patients with cT1 N0 M0 non-small cell lung cancer were enrolled. A radioisotope tracer (4 mCi of technetium-99m tin colloid, 2.0 mL) was injected in the vicinity of the tumor before surgical intervention with computed tomographic guidance. The radioactivity of each resected lymph node was measured separately with a hand-held gamma probe after complete tumor resection. Sentinel nodes were identified, and the accuracy of sentinel node mapping was examined. Whether the location of the sentinel node depended on the site of the primary tumor was also examined.. Of the 65 patients, 3 were excluded because of the final pathologic results. Successful radionuclide migration occurred in 39 (62.9%) of the 62 patients. There was 1 (2.6%) false-negative result among 39 patients with a sentinel node, and therefore the sensitivity was 90%, and the specificity was 100%. The most common sentinel lymph nodes were at level 12 (46.7%), followed by level 11 (18.3%), the mediastinum (16.7%), and level 10 (11.7%).. The sentinel node concept is valid in patients with cT1 N0 M0 lung cancer. The lobar lymph nodes were identified as sentinel nodes more frequently than other lymph nodes. We need to make further efforts to increase the sentinel node identification rate. However, we believe that if sentinel nodes are identified, sentinel node mapping can allow the accurate intraoperative diagnosis of pathologic N0 status in patients with cT1 N0 M0 lung cancer.

Topics: Aged; Carcinoma, Non-Small-Cell Lung; Carcinoma, Small Cell; False Negative Reactions; Female; Forced Expiratory Volume; Humans; Japan; Lung Neoplasms; Male; Middle Aged; Neoplasm Staging; Predictive Value of Tests; Radioisotopes; Radiopharmaceuticals; Sensitivity and Specificity; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid; Vital Capacity

Assessment of sentinel nodes to predict metastases in a regional nodal basin is valuable for staging patients with melanoma and breast carcinoma. This study tested whether injection of isosulfan blue and technetium-99 could identify mediastinal sentinel nodes in patients with lung carcinoma and determine whether sentinel node histology predicts distal nodal metastases.. Isosulfan blue and technetium-99 were injected into the tumor and pulmonary resection performed. The hilum and mediastinum were assessed visually and with the gamma probe, and a mediastinal nodal dissection was performed.. Thirty-one patients were evaluated. Three patients had positive sentinel nodes and positive distal mediastinal nodes. Twenty-two patients had negative sentinel nodes and negative distal nodes. No sentinel node was identified in 6 patients and 2 patients had two sentinel nodes.. These data demonstrate that this rapid, simple technique can identify sentinel nodes in the mediastinum and that the sentinel node is an accurate predictor of distal nodal metastases in patients with lung cancer.

Topics: Aged; Carcinoid Tumor; Carcinoma, Non-Small-Cell Lung; Carcinoma, Small Cell; Female; Humans; Injections, Intralesional; Lung Neoplasms; Lymph Node Excision; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Pneumonectomy; Prognosis; Rosaniline Dyes; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

Lymph node metastases are the most significant prognostic factor in localized non-small-cell lung cancer (NSCLC). Nodal micrometastases may not be detected with current standard histologic methods. We performed intraoperative technetium-99m ((99m)Tc) sentinel lymph node (SN) mapping in patients with resectable NSCLC. This study aimed to identify the first station of nodal drainage of operable lung cancers. Serial section histology and immunohistochemistry were used to validate the SN and to identify the presence of micrometastatic disease.. One hundred patients with potentially resectable suspected NSCLC were enrolled. At thoracotomy, the primary tumor was injected with 0.25 to 2 mCi (99m)Tc. Intraoperative scintigraphic readings of both the primary tumor and lymph nodes were obtained with a hand-held gamma counter. Anatomic resection with a mediastinal node dissection was then performed.. Nine of the 100 patients did not have NSCLC (seven benign lesions and two metastatic tumors) and were excluded. Seventy-eight (86%) of 91 patients had a SN identified and a complete resection. Sixty-nine (88.5%) out of the 78 SNs were classified as true-positive with no metastases found in other intrathoracic lymph nodes without concurrent SN involvement. In nine patients, the SN was the only positive node. In seven of these nine patients, the SN was found to harbor only micrometastatic disease.. Intraoperative SN mapping with (99m)Tc is an accurate way to identify the first site of lymphatic tumor drainage in NSCLC. This method may also improve the precision of pathologic staging.

Topics: Adult; Aged; Carcinoma, Non-Small-Cell Lung; Feasibility Studies; Female; Humans; Intraoperative Period; Lung Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

Lymph node metastases are the most significant prognostic factor in localized non-small cell lung cancer (NSCLC). Nodal micrometastases may not be detected. Identification of the first nodal drainage site (sentinel node) may improve detection of metastatic nodes. We performed intraoperative Technetium 99m sentinel lymph node (SN) mapping in patients with resectable NSCLC.. Fifty-two patients (31 men, 21 women) with resectable suspected NSCLC were enrolled. At thoracotomy, the primary tumor was injected with 2 mCi Tc-99. After dissection, scintographic readings of both the primary tumor and lymph nodes were obtained with a handheld gamma counter. Resection with mediastinal node dissection was performed and findings were correlated with histologic examination.. Seven of the 52 patients did not have NSCLC (5 benign lesions, and 2 metastatic tumors) and were excluded. Forty-five patients had NSCLC completely resected. Mean time from injection of the radionucleide to identification of sentinel nodes was 63 minutes (range 23 to 170). Thirty-seven patients (82%) had a SN identified; 12 (32%) had metastatic disease. 35 of the 37 SNs (94%) were classified as true positive with no metastases found in other intrathoracic lymph nodes without concurrent SN involvement. Two inaccurately identified SNs were encountered (5%). SNs were mediastinal (N2) in 8 patients (22%).. Intraoperative SN mapping with Tc-99 is an accurate way to identify the first site of potential nodal metastases of NSCLC. This method may improve the precision of pathologic staging and limit the need for mediastinal node dissection in selected patients.

Topics: Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Feasibility Studies; Female; Humans; Intraoperative Period; Lung Neoplasms; Lymph Nodes; Male; Middle Aged; Pilot Projects; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

LL1, a monoclonal antibody (MAb) to HLA Class-II-like antigen (li determinant) on the surface of B-lymphocytes, monocytes and histiocytes, was evaluated as an agent for bone marrow imaging. Six patients with diverse diseases (non-Hodgkin's lymphoma, n = 2; multiple myeloma, n = 1; polycythaemia vera, n = 1; lung cancer, n = 1; breast cancer, n = 1) were given low protein doses (< 1 mg) of 99Tcm (30 mCi) labelled Fab' of LL1. 99Tcm-sulphur colloid (SC) imaging was performed in three patients for comparison. Both planar and single photon emission tomographic images were acquired using Sopha gamma cameras. As early as 2 h post-MAb injection, excellent bone marrow images were achieved in all patients, demonstrating both normal or hyperproliferative marrow, as well as 'cold' bone marrow abnormalities such as radiation defects or cancer metastases. Similar to SC, relatively high uptake of LL1 was found in the liver and spleen. However, the bone marrow-to-liver and -spleen uptake ratios were approximately 19-fold higher (0.75 vs 0.04) and 6-fold higher (1.23 vs 0.22), respectively, with LL1 than with SC. The higher bone marrow uptake allowed clearly superior visualization of the thoracic spine when compared to SC. The mean T1/2 of blood and whole-body clearance were 0.4 and 66 h, respectively. The highest radiation absorbed doses (in cGy mCi-1) were observed in the spleen (0.47 +/- 0.24), kidneys (0.25 +/- 0.09) and liver (0.14 +/- 0.04). The bone marrow dose was only 0.05 +/- 0.02 cGy mCi-1. These results indicate that bone marrow imaging with 99Tcm-LL1 is feasible, and that LL1 may be a suitable alternative to SC because of better visualization of the lower thoracic spine. Potential applications include the improved detection of bone marrow metastases of solid tumours and the assessment of haematological disorders.

Topics: Animals; Antibodies, Monoclonal; Bone Marrow; Breast Neoplasms; Female; Humans; Lung Neoplasms; Lymphoma, Non-Hodgkin; Mice; Multiple Myeloma; Neoplasms; Polycythemia Vera; Radioimmunodetection; Technetium; Technetium Tc 99m Sulfur Colloid; Tissue Distribution; Tomography, Emission-Computed

The authors present a case that demonstrates the continued high sensitivity of Tc-99m SC liver-spleen imaging for thoracic splenosis. A patient with profound weight loss, positive PPD and left upper lobe lung density on a chest radiograph was felt to have a strong clinical suspicion of a malignant pulmonary lesion. Two needle biopsies of the lesion were consistent with splenic tissue. Transbronchial biopsy of the right lower lobe lung revealed metastatic adenocarcinoma of an unknown origin. A Tc-99m SC liver-spleen scan of the abdomen and thorax indicated the lung density was consistent with thoracic splenosis.

Topics: Adenocarcinoma; Adult; Humans; Liver; Lung Diseases; Lung Neoplasms; Male; Neoplasms, Unknown Primary; Radionuclide Imaging; Sensitivity and Specificity; Spleen; Splenosis; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

A case of a primary lung carcinoma involving the left pulmonary hilum serendipitously detected utilizing hepatic imaging is presented. Malignant stimulation of the reticuloendothelial system resulted in diffuse pulmonary uptake of Tc-99m sulfur colloid, however, only the right lung was visualized. Subsequently, a chest radiograph and computed tomography of the chest demonstrated massive malignant involvement of the left pulmonary hila, adjacent mediastinum, and left atrium. Transbronchial biopsy revealed anaplastic small cell carcinoma.

Topics: Adult; Carcinoma, Small Cell; Female; Humans; Liver; Lung Neoplasms; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Three clinically unsuspected malignant pericardial effusions were discovered during routine dynamic hepatic scintigraphy. The only common clinical feature shared by the patients was dyspnea. Static scintigrams alone would not have detected these effusions, which points out again the importance of including dynamic scintigraphy in routine radionuclide evaluations of the liver.

Topics: Aged; Breast Neoplasms; Female; Humans; Liver; Lung Neoplasms; Lymphoma; Male; Middle Aged; Pericardial Effusion; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

To determine the accuracy of liver sonography in the diagnosis of liver metastases, the results of 99 patients with breast or lung cancer were compared with liver scintigraphy, physical examination, laboratory tests, histological examination and clinical follow-up. Liver sonography proved to be an accurate method to demonstrate or exclude liver metastases, with a sensitivity of 78.6% and a specificity of 90.0%. The highest accuracy was achieved if the sonographic examination of the liver was performed while there was a clinical suspicion of liver metastases and if compoundscan sonography was supplemented by real-time sonography.

Topics: Breast Neoplasms; Carcinoma, Bronchogenic; Humans; Liver Function Tests; Liver Neoplasms; Lung Neoplasms; Physical Examination; Retrospective Studies; Technetium Tc 99m Sulfur Colloid; Ultrasonography

Topics: Aged; Diagnosis, Differential; False Positive Reactions; Humans; Liver; Liver Neoplasms; Lung Neoplasms; Male; Radionuclide Imaging; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

A patient with squamous cell carcinoma of the lung had splenic uptake of Tc-99m MDP on two consecutive bone scans, but not on a third. There was no intervening therapy. At autopsy the spleen was grossly and microscopically normal.

Topics: Bone and Bones; Carcinoma, Bronchogenic; Carcinoma, Squamous Cell; Diphosphonates; Humans; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Spleen; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

A retrospective analysis of 104 chest radionuclide angiography (CRNA) studies establishes the utility of this procedure in the evaluation of pulmonary malignancies and benign masses. Remarkable abnormalities in the perfusion of the lungs were identified in 36 (58%) of 62 cases that were not predictably normal or predictably abnormal form the clinical setting. While 60 of these 62 cases involved malignancy being evaluated for metastases, only 21 (34%) had metastases identified by radionuclide bone or liver-spleen scintigraphy. In addition to diagnosis of superior vena cava obstruction, the CRNA may have a more frequent application as an adjunct to routine scintigraphic studies directed to the identification of metastatic disease.

Topics: Adenocarcinoma; Aged; Carcinoma, Squamous Cell; Diphosphonates; Female; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Vena Cava, Superior

The concentration of granulocyte-macrophage colonies in culture (CFU-c) in bone marrow cells was estimated, and bone marrow radionuclide scans were performed in a group of 15 cancer patients prior to bone marrow harvest for autologous transplantation. Preharvest CFU-c counts on iliac-crest bone marrow aspirates correlated very well with CFU-c counts from fresh and frozen-thawed bone marrows. Technetium-99m-sulfur colloid radionuclide scans showed that the distribution of total-body bone marrow and increased peripheral radionuclide uptake correlated with higher preharvest and harvest CFU-c counts. Bone marrow scan results were available in 1 h, whereas CFU-c counts took 14 days to obtain. Bone marrow scans may facilitate the clinical estimation of hemopoietic activity in patients under consideration for autologous bone marrow transplantation.

Topics: Bone Marrow; Breast Neoplasms; Carcinoma, Small Cell; Colony-Forming Units Assay; Hematopoiesis; Humans; Leukemia; Lung Neoplasms; Lymphoma; Male; Neoplasms; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Testicular Neoplasms

The purpose of this study was to determine what effect further improvement in an Anger camera's intrinsic resolution has on lesion detection. We studied 52 patients undergoing bone imaging and 58 undergoing liver imaging. All patients had images performed in rapid sequence on ZLC -75 and ZLC -37 Anger cameras, both by Siemens. The two imaging systems are virtually identical except for the number of photomultiplier tubes and crystal thickness; these resulted in differences in intrinsic resolution ( ZLC -75 less than 3.8 mm FWHM at 140 keV, ZLC -37 less than 4.9 mm) and sensitivity ( ZLC -75 approximately 0.91 of ZLC -37 at 140 keV). Observer performance, measured by ROC curves, for detection of abnormalities was virtually identical with the two instruments. Subjectively, there was a trend toward preference of the ZLC -75 images, but this was not associated with any significant improvement in lesion detectability even in the subgroup in which a preference for one or the other instrument was noted.

Topics: Bone and Bones; Breast Neoplasms; Female; Humans; Image Enhancement; Liver; Lung Neoplasms; Male; Prostatic Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

One hundred fifty-seven consecutive patients with small cell lung cancer seen at the National Cancer Institute over a four-year period underwent a series of pretherapy liver staging procedures to determine optimal means of detection and prognostic implications of hepatic metastases. Liver evaluation included physical examination, liver function tests, and liver scan (radionuclide or computerized tomography [CT]), as well as percutaneous and/or peritoneoscopy-directed liver biopsy when possible (74%). Liver metastases were detected in 26% of patients. Peritoneoscopy was the most sensitive method of liver evaluation and increased the detection of liver metastases when done in a sequential fashion after percutaneous liver biopsy from 18 to a total of 27 patients. Of the noninvasive procedures, radionuclide and CT liver scan were the most accurate concurring with liver biopsy in 87% of patients but permitting correct discrimination of stage in excess of 96% of patients. The accuracy of this noninvasive procedure was enhanced by an algorithm combining the results of radionuclide liver scan with liver function tests to detect patients with high or low likelihood of liver involvement. The survival and response of patients with liver metastases was significantly worse than those without such metastases with no three-year disease-free survivors among patients with liver metastases.

Topics: Actuarial Analysis; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Carcinoma, Small Cell; Female; Humans; Liver Function Tests; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Neoplasm Staging; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray 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

Topics: Adenocarcinoma; Aged; Humans; Imino Acids; Liver Neoplasms; Lung Neoplasms; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid

The difficulty of clinical and radiographical diagnosis of hepatoma is discussed. A case of hepatoma is reported. Both the primary tumor and distant metastases showed strong avidity for 99mTc-HIDA, which normally is concentrated by parenchymal cells of the liver. The potential of using 99mTc-HIDA for the noninvasive investigation of patients suspected of having hepatoma is discussed. The association between tumor avidity for 99mTc-HIDA and the bile-forming ability of tumor cells is of interest.

Topics: Adult; Carcinoma, Hepatocellular; Diagnosis, Differential; Gallium Radioisotopes; Hemangioma; Humans; Imino Acids; Iodine Radioisotopes; Liver; Liver Neoplasms; Lung Neoplasms; Lymphoma; Male; Radionuclide Imaging; Rose Bengal; Sulfur; Technetium; Technetium Tc 99m Lidofenin; 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

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

Topics: Adolescent; Adult; Aged; Carcinoma, Bronchogenic; Female; Hemoptysis; Humans; Lung; Lung Diseases, Obstructive; Lung Neoplasms; Male; Middle Aged; Radiography; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tuberculosis, Pulmonary

Pulmonary hemorrhage, whether in the form of hemoptysis or bleeding into the pleural space, may be a life threatening problem. While fiberoptic bronchoscopy and selective bronchial and intercostal angiography are the major diagnostic modalities, these techniques are not without risks. Two patients are described-one with massive hemoptysis from a bronchogenic carcinoma; another with pleural bleeding from a torn intercostal artery-in whom Tc-99m-sulfur colloid scintigraphy accurately located the source of hemorrhage. We conclude that Tc-99m-sulfur colloid scintigraphy may be a helpful noninvasive method to increase the sensitivity and specificity of fiberoptic bronchoscopy and bronchial angiography in patients with massive pulmonary bleeding.

Topics: Adult; Angiography; Bronchoscopy; Carcinoma, Bronchogenic; Diagnosis, Differential; Fiber Optic Technology; Hemoptysis; Hemorrhage; Humans; Lung Diseases; Lung Neoplasms; Male; Middle Aged; Pleura; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid