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Background. This study evaluates a novel method of intraoperative localization of endocrine gastroenteropancreatic tumors with a hand-held γ-detecting probe to detect in situ tumor binding of the radioiodinated somatostatin analog 125I-TYR(3)-octreotide.
Methods. Seven patients with biochemical and radiologic evidence of a specific endocrine tumor, one patient with biochemical evidence of gastrinoma but no tumor localized by conventional imaging techniques, and four patients with equivocal preoperative biochemical or radiologic study results but suspected of harboring a neuroendocrine tumor underwent abdominal exploration with intraoperative injection of 125I-TYR(3)-octreotide, 298 ± 63 μCi. A hand-held γ-detecting probe was used during operation to determine whether gross tumor accumulated the radiolabeled analog and occult tumor could be detected. Positive uptake was defined as tumor/background ratios exceeding 2:1.
Results. The tumor in all seven patients with gross disease accumulated 125I-TYR(3)-octreotide. Occult tumor beyond that appreciated with preoperative imaging or by routine operative exploration was detected in a patient with carcinoid tumor. In the patient with the occult gastrinoma the probe detected the lesion within the duodenal bulb before duodenotomy and also predicted what proved histologically to be positive peripancreatic adenopathy. There was a single false-positive reading from the stomach in a patient with suspected carcinoid tumor in whom no tumor could be found grossly or histologically. A pancreatic mass that probed negative proved to be an adenocarcioma of ductal origin.
Conclusions. Tumor-specific peptide-receptor binding can be detected in situ with 125I- TYR(3)-octreotide and a hand-held γ-detecting probe. This technique may facilitate neuroendocrine tumor localization and operative cytoreduction.
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☆Supported by the Clinical Research Center of The Ohio State University (NIH, GCRC, RR-34).
☆☆Presented at the Fiftieth Annual Meeting of the Central Surgical Association, Cincinnati, Ohio, March 4–6, 1993.
© 1993 Published by Elsevier Inc.