99mTc-anti-CEA radioimmunoscintigraphy of lung adenocarcinoma.
99mTc-anti-CEA radioimmunoscintigraphy of lung adenocarcinoma.
复制标题
肺腺癌的 99mTc-抗 CEA 放射免疫闪烁显像。
作者：
T. Leitha;R. Walter;W. Schlick;R. Dudczak
据报道，在结直肠腺癌中，抗癌胚抗原放射免疫显像（anti-CEA RIS）比其他放射学方法更能估计局部肿瘤的扩展。本研究评价了99 mTc标记的抗CEA单克隆抗体（BW 431/26，Behring Institute，FRG）用于11例原发性肺腺癌分期的临床可行性。原发肿瘤直径3 ~ 8 cm，平均4cm。4例患者存在纵隔和肺门淋巴结，2例患者存在肺内转移，1例患者存在胸膜和肝转移。CEA水平在2至265 ng/ml范围内，6例患者升高（大于5 ng/ml）。在注射后6 h和24 h（pi）进行平面动脉造影。模拟和数字化图像由两名观察员解释。一名患者进行了两次成像，并在第二次研究后因人抗小鼠抗体（HAMA）而出现血清病，显示肝脏、脾脏和骨髓中有明显的非特异性示踪剂摄取，但肿瘤无特异性摄取，因此被排除在进一步分析之外。目视判读在7名患者中清楚地识别出原发性肿瘤。两名患者未观察到肿瘤成像。2例患者由于肿瘤摄取与纵隔血池分离不良而被归类为可疑成像。经与胸片比较，两例患者的原发肿瘤均能清楚地显示。因此，原发性肿瘤成像的总体灵敏度为82%。平均靶/背景比在感染后6小时为1.31 +/- 0.17：1，在感染后24小时为1.30 +/- 0.16：1。3例患者的肺门和纵隔淋巴结被正确怀疑，但心血池妨碍了清晰的解释。所有病例均诊断为肺内和胸膜转移。由于非特异性示踪剂摄取高，漏诊了单个肝转移瘤。1例肿瘤次全切除者，99 mTc BW 431/26平面抗CEA RIS优于CT（上级）。我们总结，目前，平面抗CEA RIS与99 mTc BW 431/26不建议作为一个常规的分期程序在肺腺癌，但它可能有助于检测残留或复发的肿瘤组织。
Anti-carcinoembryonic antigen radioimmunoscintigraphy (anti-CEA RIS) in colorectal adenocarcinoma has been reported to allow a better estimation of the local tumor extension than other radiologic methods. This study evaluated the clinical feasibility of a 99mTc-labeled anti-CEA monoclonal antibody (BW 431/26, Behring Institute, FRG) in 11 patients for staging of primary adenocarcinoma of the lung. The primary tumor size ranged from 3 to 8 cm with a mean of 4 cm. Mediastinal and hilar nodes were present in four patients, intrapulmonary metastases were present in two patients, and pleural and liver metastases were present in one patient each. The CEA levels were in the range of 2 to 265 ng/ml and elevated (greater than 5 ng/ml) in six patients. Planar scintigraphy was performed at 6 h and 24 h post injection (pi). Analog and digitized images were interpreted by two observers. One patient was imaged twice and experienced serum sickness due to human anti-mouse antibodies (HAMA) after the second study, which showed marked unspecific tracer uptake in liver, spleen, and bone marrow, but no specific uptake by the tumor and was excluded from further analysis. Visual interpretation identified the primary tumor clearly in seven patients. No tumor imaging was observed in two patients. Two patients were classified as having questionable imaging due to a poor separation of tumor uptake from mediastinal blood pool. The primary tumor could be clearly delineated in both patients after comparison with the chest radiograph. Thus, the overall sensitivity for imaging of the primary tumor was 82 percent. The average target/background ratio was 1.31 +/- 0.17:1 at 6 h pi, and 1.30 +/- 0.16:1 at 24 h pi. Hilar and mediastinal nodes were correctly suspected in three patients, but the cardiac blood pool hampered a clear interpretation. Intrapulmonary and pleural metastases were diagnosed in all cases. The single liver metastasis was missed because of the high unspecific tracer uptake. Planar anti-CEA RIS with 99mTc BW 431/26 was superior to computed tomography (CT) in one case with subtotal tumor resection. We summarize that at present, planar anti-CEA RIS with 99mTc BW 431/26 cannot be advised as a routine staging procedure in adenocarcinoma of the lung, but it may be helpful in the detection of residual or recurrent tumor tissue.