technetium-tc-99m-tetrofosmin and Neoplasm-Metastasis

Topics: Adult; Artifacts; Axilla; Biopsy; Breast Diseases; Breast Neoplasms; Carcinoma; Carcinoma, Ductal, Breast; Chemotherapy, Adjuvant; Drug Resistance, Multiple; Drug Resistance, Neoplasm; False Positive Reactions; Female; Forecasting; Humans; Lymphatic Metastasis; Magnetic Resonance Imaging; Mammography; Middle Aged; Multicenter Studies as Topic; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasms, Multiple Primary; Organophosphorus Compounds; Organotechnetium Compounds; Patient Selection; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Ultrasonography

99m-Tc-tetrofosmin holds significant interest among medical oncologists because of its high positive predictive value (>90%) in pilot trials, exceeding sensitivity and specificity rates of mammography. Objective. Our objective was to assess the diagnostic accuracy of 99m-Tc-tetrofosmin whole-body scintigraphy in outpatients.. Thirty-one patients with an abnormal mammograph (n = 22) or follow-up patients (n = 9), 7 of whom were known to have metastatic disease, were included. Tracer (550 MBq) was injected into the cubital vein. Whole-body planar and single photon emission computed tomography images of regions of interest were obtained. Histology, computed tomography (CT), or magnetic resonance imaging (MRI) were performed to confirm scintigraphic results. Correlation between scintigraphy and CT or MRI was assessed by two independent radiologists. Accuracy, sensitivity, and specificity rates for the diagnosis of local and distant breast cancer lesions were given.. Of the 22 first-visit patients, 15 had breast cancer, and 7 had no evidence of any malignant disease. Of all patients examined (n = 31), 21 had distant metastases. Breast tumors were correctly diagnosed in 14/15 patients (93%), with only 1 false-negative result. Extrahepatic metastatic lesions (n = 16) were correctly diagnosed in 14 (88%) patients, whereas the method was not suitable for the diagnosis of liver metastases.. Tetrofosmin scintigraphy has shown very high detection rates of breast tumors and of metastatic lesions and is therefore a valuable option in breast cancer diagnosis.

Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Female; Humans; Middle Aged; Neoplasm Metastasis; Organophosphorus Compounds; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity

99mTC-tetrofosmin recently has emerged as a new radiopharmaceutical for cancer visualization. In this study, the authors have investigated, for the first time in a comprehensive way, its ability to assess lung carcinoma dissemination and progression.. A 99mTC-tetrofosmin scan was incorporated into the pretreatment and posttreatment diagnostic workup of all lung carcinoma patients seen in a second referral institution for a province of 500,000 inhabitants during the years 1998 and 1999. Sixty-one patients, strongly suspected of lung carcinoma were photon-scanned; 21 of them were rescanned after completion of their front-line treatment. Eleven patients eventually underwent surgery, and 3 others underwent mediastinoscopy. Both planar and single photoemission computed tomography thoracic views were obtained. Images for the whole body also were acquired.. All 57 patients whose lung carcinoma was pathologically confirmed showed accumulation of the radiotracer (100% sensitivity). However, three of the four nonmalignant lesions were also 99mTC-tetrofosmin positive. 99mTC-tetrofosmin scan was highly sensitive for the detection of the T0-T2 disease (97% sensitivity) and highly specific for the N0-N1 disease (83% specificity). In the 16 pathologically staged mediastina, sensitivity, specificity, and accuracy rates were 73%, 100%, and 81%, respectively. 99mTC-tetrofosmin scan correctly detected most skeleton (9 of 10) and brain (5 of 7) metastases. The treatment response evaluation made with 99mTC-tetrofosmin corresponded to the clinical estimate in almost half of the sample.. This study shows that 99mTC-tetrofosmin scan is a relatively accurate method for lung carcinoma evaluation. The authors' preliminary data exclude, however, that noninvasive diagnostic efficiency might be substantially increased by a scintigraphy with 99mTC-tetrofosmin. More studies are needed for a better understanding of the real value of this technique.

Topics: Adult; Aged; Aged, 80 and over; Disease Progression; Female; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity

99m-Tc-tetrofosmin holds significant interest among medical oncologists because of its high positive predictive value (>90%) in pilot trials, exceeding sensitivity and specificity rates of mammography. Objective. Our objective was to assess the diagnostic accuracy of 99m-Tc-tetrofosmin whole-body scintigraphy in outpatients.. Thirty-one patients with an abnormal mammograph (n = 22) or follow-up patients (n = 9), 7 of whom were known to have metastatic disease, were included. Tracer (550 MBq) was injected into the cubital vein. Whole-body planar and single photon emission computed tomography images of regions of interest were obtained. Histology, computed tomography (CT), or magnetic resonance imaging (MRI) were performed to confirm scintigraphic results. Correlation between scintigraphy and CT or MRI was assessed by two independent radiologists. Accuracy, sensitivity, and specificity rates for the diagnosis of local and distant breast cancer lesions were given.. Of the 22 first-visit patients, 15 had breast cancer, and 7 had no evidence of any malignant disease. Of all patients examined (n = 31), 21 had distant metastases. Breast tumors were correctly diagnosed in 14/15 patients (93%), with only 1 false-negative result. Extrahepatic metastatic lesions (n = 16) were correctly diagnosed in 14 (88%) patients, whereas the method was not suitable for the diagnosis of liver metastases.. Tetrofosmin scintigraphy has shown very high detection rates of breast tumors and of metastatic lesions and is therefore a valuable option in breast cancer diagnosis.

Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Female; Humans; Middle Aged; Neoplasm Metastasis; Organophosphorus Compounds; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity

Topics: Brain; Brain Neoplasms; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Necrosis; Neoplasm Metastasis; Organophosphorus Compounds; Organotechnetium Compounds; Positron-Emission Tomography; Radiation Injuries; Radiopharmaceuticals; Recurrence; Tomography, Emission-Computed, Single-Photon

A correct differential diagnosis between benign and malignant lesions is mandatory in patients with solitary pulmonary nodule (SPN). The aim of the present study was to investigate whether 99mTc-tetrofosmin SPECT may play a role in SPN evaluation. A consecutive series of 111 patients with an uncalcified

Topics: Aged; Female; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Organophosphorus Compounds; Organotechnetium Compounds; Radiographic Image Interpretation, Computer-Assisted; Radionuclide Imaging; Radiopharmaceuticals; Solitary Pulmonary Nodule; Tomography, Emission-Computed, Single-Photon

Diagnosis and staging of laryngeal cancer is currently based on physical examination, endoscopy, and imaging techniques such as computed tomography (CT) and/or magnetic resonance (MR) and histology. While imaging techniques have a pivotal role for defining the size of the primary tumor, they are less accurate for defining metastatic involvement of regional lymph nodes, especially if lymph nodes are smaller than 10-15 mm. The aim of this study was to comparatively assess the relevance of (99m)Tc-tetrofosmin scintigraphy for the staging of laryngeal tumors versus the CT scan. We evaluated the sensitivity of imaging with (99m)Tc-tetrofosmin in 28 consecutively enrolled patients with squamous cell laryngeal carcinoma. Total-body scintigraphy with 99mTc-tetrofosmin was performed preoperatively, and the results were compared to CT images of the neck and mediastinum. CT and (99m)Tc-tetrofosmin scintigraphy were equally sensitive (96%) in identifying the primary tumor. While CT was more sensitive for detecting metastatic lymph nodes (100% versus 50%), (99m)Tc-tetrofosmin scintigraphy was more specific (100% versus 56%; p < 0.04). The overall diagnostic capabilities of the two techniques for detecting lymph node metastases were comparable (Youden Index: J = 0.56 for CT and J = 0.50 for (99m)Tc-tetrofosmin scintigraphy). (99m)Tc-tetrofosmin scintigraphy is a useful complement to CT for staging laryngeal tumors, especially for detecting metastatic lymph nodes and distant metastases.

Topics: Aged; Aged, 80 and over; Humans; Image Processing, Computer-Assisted; Laryngeal Neoplasms; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Neoplasm Metastasis; Neoplasm Staging; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The aim of this study was to evaluate the effectiveness of technetium-99m tetrofosmin (Tc-99m TF) single photon emission computed tomography (SPECT) of the neck and chest to detect metastatic lesions in papillary thyroid carcinoma (PTC) after near total thyroidectomy and radioiodine (I-131) treatment in patients who present with elevated serum human thyroglobulin (hTg) levels but negative I-131 whole body scan (WBS).. Twenty patients with PTC treated by near total thyroidectomy and I-131 treatments were included in this study. All 20 patients had negative I-131 WBS results and elevated hTg levels (hTg 2.0 microIU/ml) under thyroid-stimulating hormone (TSH) stimulation (TSH 30 microIU/ml). Nineteen of the 20 cases were confirmed to have metastases by operation/biopsy histopathological findings or clinical follow-up longer than 1 year by additional morphological imaging techniques. The remaining patient has been followed up closely and has been disease free for 10 months. Tc-99m TF SPECT was performed to detect metastatic lesions.. Tc-99m TF SPECT demonstrated lesions in 11/19 patients; a sensitivity of 57.9%. Tc-99m TF SPECT failed to demonstrate lesions in eight patients including smaller lymph nodes and miliary lung metastases.. We conclude that Tc-99m TF SPECT is a useful additional tool to detect metastatic lesions in PTC with elevated hTg but negative I-131 WBS. However, smaller lymph nodes and miliary lung metastases may be missed.

Topics: Adult; Aged; Carcinoma, Papillary; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Neoplasm Metastasis; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Sensitivity and Specificity; Thyroglobulin; Thyroid Neoplasms; Tomography, Emission-Computed, Single-Photon; Whole-Body Irradiation

The most important prognostic factor in breast (B) cancer (C) is axillary (A) lymph (L) node (N) status, and virtually all patients with BC undergo ALN dissection to assess N involvement. The aim of this study was to evaluate the accuracy of planar and tomographic Tc-99m tetrofosmin scintigraphy in the detection of ALN involvement in BC. A group of 85 female patients (age range: 31-82 years) with 87 BCs were studied before surgery. Three planar images, right and left prone lateral and supine anterior thoracic views, and 360 degrees supine thoracic single photon emission tomography (SPET) were acquired after Tc-99m tetrofosmin injection (740 MBq i.v.). ALN status was evaluated by histological exam after A dissection: metastatic ALN involvement was proved in 31 out of 87 cases. Sensitivity was 87.1% (27/31) for SPET and 61.3% (19/31) for planar images (p<0.01); specificity was 92.9% (52/56) and 94.6% (53/56), respectively, with a global accuracy of 90.8% (79/87) for SPET and 82.8% (72/87) for planar imaging (p<0.05). Sensitivity rose from 75% in non-palpable Ns to 94.7% in palpable ones for SPET, and from 41.7 to 73.7% for planar scans. SPET was positive in 17/18 (94.4%) patients with >3 metastatic Ns and in 10/13 (76.9%) with < or = 3 involved Ns, whereas planar images were positive in 14/18 (77.8%) and in 5/13 (38.5%) cases, respectively. In conclusion, our findings indicate that Tc-99m tetrofosmin scintigraphy is useful in the presurgical detection of ALN metastases in BC, with SPET more accurate than conventional planar images, thus suggesting its more frequent use in scintimammography; moreover, the total number of histologically involved Ns can affect the scintigraphic results.

Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Female; Humans; Lymphatic Metastasis; Middle Aged; Neoplasm Metastasis; Organophosphorus Compounds; Organotechnetium Compounds; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

The aim of this study was to evaluate Tc-99m-tetrofosmin whole-body imaging in the detection of metastases in patients with malignant melanoma.. In 30 patients with suspected melanoma metastases we performed whole body imaging. After administration of about 600 MBq Tc-99m-tetrofosmin dynamic images up to 10 min were performed in 7 patients (1 image per 10 sec) to evaluate the optimal tracer uptake in the metastases. In all patients whole-body images were performed 5-10 min p.i. using an acquisition time of 5 min per image. The final diagnosis was confirmed by surgical histology in 30 lesions, by computertomography and clinical course in the remaining lesions.. Out of 64 melanoma metastases 49 were detected using Tc-99m-tetrofosmin scintigraphy (49 rp., 15 fn.). The overall sensitivity for the detection of malignant lesions was 77%. Referring only to the lymph node metastases, the sensitivity was 87% (26 rp.; 4 fn.). The maximal tracer uptake was reached 1 min after injection, with a slow decrease in the following 10 minutes. The size of the lesions ranged between 0.5 and 7.0 cm and the T/B ratios between 1.3 and 3.0 (mean 1.88).. Tc-99m-tetrofosmin whole body imaging is a simple and side-effectless method for the detection of melanoma metastases especially of lymph node metastases. The results are comparable to Tc-99m-sestamibi and Tl-201 scintigraphy.

Topics: Adult; Aged; Brain Neoplasms; Female; Humans; Lymphatic Metastasis; Male; Melanoma; Middle Aged; Neoplasm Metastasis; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity

Determination of thyroglobulin (Tg) levels, determined under endogenous thyroid-stimulating hormone stimulation after withdrawal of L-thyroxin treatment (off-T4), has been proven to be the most sensitive method for evaluation of patients with recurrent malignancy or distant metastases. This study uses a comparative approach between low-dose 131I scan and the previously reported highly sensitive 99mTc-tetrofosmin whole-body scintigraphy, using Tg-off-T4 as a basis for comparison.. Fifty-eight consecutive patients of our follow-up program with primary thyroid carcinoma ablated with thyroidectomy and radioiodine therapy were examined after L-thyroxin withdrawal over 3-4 wk with 131I (185 MBq) and 99mTc-tetrofosmin whole-body scintigraphy and Tg determination (off-T4) within 5 days. Patients with Tg levels above 0.5 ng/ml were defined as Group A (n = 29). Group B (n = 29) comprised patients who had Tg levels (off-T4) below 0.5 ng/ml.. Iodine-131 revealed only 19 of 44 tumor sites (43.18%). Additionally, three remnants could be demonstrated. Sensitivity showed decreasing values for local recurrences (4 of 7, 57.1%), bone lesions (7 of 13, 53.85%) and mediastinal (2 of 4, 50%), lung parenchymal (3 of 7, 42.85%) and lymph node (2 of 9, 22.2%) metastases. Whole-body scintigraphy with 99mTc-tetrofosmin revealed a total of 39 of 44 malignant lesions (88.6%). Sensitivity was superior for lung parenchymal metastases (9 of 9, 100%), mediastinum (4 of 4, 100%) and lymph nodes (9 of 10, 90%) and inferior for bone metastases (11 of 13, 84.6%). Local recurrences could be detected in 6 of 7 patients (85.7%), and thyroid remnants were detected in 2 cases (2 of 11, 18.2%). One liver metastasis could not be detected because of the physiologic tracer distribution of 99mTc-tetrofosmin. Thyroglobulin-off-T4 detected malignant recurrence or metastases in 18 of 19 patients (94.7%) when a cutoff of 3 ng/ml was used and in 16 of 19 patients (84.2%) when a cutoff of 10 ng/ml was used. Specificity was calculated as 71.8% when a cutoff of 0.5 ng/ml was used, 89.7% when a cutoff of 3 ng/ml was used and 100% when a cutoff of 10 ng/ml was used.. Scintigraphy with 99mTc-tetrofosmin showed clear advantages concerning sensitivity in most metastatic lesions when compared with low-dose 131I scan. Despite a slight lower specificity, 99mTc-tetrofosmin whole-body scintigraphy has, therefore, been proven to be a useful tool in the assessment of metastatic lesions in differentiated thyroid carcinoma.

Topics: Adenocarcinoma, Follicular; Carcinoma, Papillary; Case-Control Studies; Combined Modality Therapy; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Thyroglobulin; Thyroid Neoplasms; Thyroidectomy; Thyroxine

Since many years TI-201, as non-specific tumor-searching radionuclide, plays a certain although somewhat controversial role in the follow-up of differentiated thyroid carcinoma (DTC). Recently some Tc-99m labeled myocardial perfusion agents were introduced, that might be more important for nuclear oncology in the future. Aim of this study was to evaluate prospectively the reliability of the new non-specific tumor searching tracer tetrofosmin (Myoview) in the post operative follow-up of differentiated thyroid carcinoma during TSH suppressive thyroid hormone treatment and to compare the results in patients with metastasizing DTC to Tc-99m sestamibi (Cardiolite) and TI-201. In a pilot study 12 patients with elevated thyroglobulin (Tg) levels of more than 10 ng/ml and known metastatic disease were examined under TSH suppressive L-Thyroxine treatment comparing TI-201, Tc-99m sestamibi and Tc-99m terofosmin whole body scintigraphy (WBS). Furthermore in 146 consecutive follow up patients tetrofosmin WBS was performed under TSH-suppressive L-T4 treatment. The results were compared to serum thyroglobulin (Tg), ultrasonography (US) of the neck, I-131 whole body scintigraphy (I-131 WBS), transmission computed tomography (TCT) or magnetic resonance imaging (MRI) and bone scintigraphy. Whole body scans were performed with TI-201 (74 MBq; 20 min post injection), Tc-99m sestamibi (370 MBq; 20-60 min post injection) and Tc-99m tetrofosmin (370 MBq; 20-60 min post injection). Tumor/background ratios and optional time/activity analyses (up to 120 min post injection) were evaluated using the region of interest approach. In the pilot study tetrofosmin showed the highest T/BG ratios and detection rates (T/BG: 1.76 +/- 0.345) followed by TI-201 (T/BG: 1.59 +/- 0.396) and sestamibi (1.51 +/- 0.31 p = 0.05). From the 146 patients investigated consecutively with Tc-99m tetrofosmin WBS for the routine follow up of DTC, 88 patients (no thyroid remnants, no history of metastases or tumor recurrence) were tumor free. All of them resulted in negative Tc-99m tetrofosmin WBS. Another 32 patients (papillary carcinoma pT1) were also in complete remission, but had sonographically proven remnants (echonormal). Twenty one of them exhibited certain Tc-99m tetrofosmin accumulation in the thyroid bed. In 9 cases with local recurrence as confirmed by histopathology after reoperation or by cytology after fine needle aspiration, the tetrofosmin scintigraphy clearly revealed relapse of malignancy i

Topics: Adenocarcinoma, Follicular; Adult; Aged; Aged, 80 and over; Carcinoma, Papillary; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Sestamibi; Thyroid Neoplasms; Whole-Body Counting

The usefulness of the myocardial perfusion agent, Tc-99m-tetrofosmin (Myoview) in the follow-up of differentiated thyroid carcinoma was evaluated in a clinical study of 15 patients, primary treated with thyroidectomy and high-dose I-131-therapy (2960-3700 MBq). 12 with suspected recurrence and metastases and three patients without any suspicion and compared with other non-specific tracers like TI-201 and Tc-99m-sestamibi.. Twelve patients with elevated thyroglobulin (Tg) levels of more than 10 ng/ml (group A), four of these had negative I-131 scans, and three patients with Tg levels less than 10 ng/ml (group B) were examined under TSH suppressive L-Thyroxine treatment. Whole body scans were taken with Tl-201 (74 MBq: 20 mn post injection), Tc-99m-sestamibi (370 MBq: 20-60 min post injection) and Tc-99m-tetrofosmin (370 MBq: 20-60 min post injection). Tumor/background ratios and optional time/activity analyses (up to 150 min post injection) were evaluated using the region of interest approach.. Compared with Tl-201 (T/BG: 1.59, +/- 0.396). Tc-99m-tetrofosmin showed slightly but not significant better T/BG ratios and detection rates (T/BG: 1.76, +/- 0.345). Tc-99m-sestamibi (1.51, +/- 0.31 p = 0.05) showed significantly lower values than Tc-99m-tetrofosmin. In the light of these results, scintigraphy with Tc-99m-tetrofosmin seems to be a possibly sensitive imaging modality in the follow-up of DTC with possible advantages concerning T/Bg ratio, background clearance, detection rate and dosimetry compared with Tl-201 and Tc-99m-sestamibi, especially in patients with elevated Tg level and no iodine uptake, but further investigations are needed to confirm our preliminary results.

Topics: Aged; Aged, 80 and over; Analysis of Variance; False Negative Reactions; False Positive Reactions; Female; Follow-Up Studies; Humans; Iodine Radioisotopes; Male; Middle Aged; Neoplasm Metastasis; Organophosphorus Compounds; Organotechnetium Compounds; Radioimmunoassay; Radionuclide Imaging; Recurrence; Reproducibility of Results; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Thyroglobulin; Thyroid Neoplasms; Time Factors

99Tcm-tetrofosmin imaging was performed in 23 thyroid cancer patients and compared with whole-body 131I scans, neck ultrasonography and plasma thyroglobulin levels. Of 22 patients with differentiated thyroid cancer, 8 showed identical images on 131I scan and tetrofosmin; 1 patient with medullary cancer had identical images with 99Tcm-DMSA and 99Tcm-tetrofosmin, the findings being confirmed by sonography. The potential usefulness of 99Tcm-tetrofosmin imaging in the follow-up of thyroid cancers is discussed.

Topics: Biomarkers, Tumor; Follow-Up Studies; Humans; Iodine Radioisotopes; Lymphatic Metastasis; Neoplasm Metastasis; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroglobulin; Thyroid Neoplasms; Ultrasonography