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P-Glycoprotein Expression by Technetium-99m-MIBI Scintigraphy in Hematologic Malignancy

Departments of Nuclear Medicine and Medical Oncology, Hacettepe University Medical Faculty, Ankara; Department of Basic Oncology and Cancer Epidemiology, Hacettepe University Oncology Institute, Ankara; Department of Nuclear Medicine, Uludag University Medical Faculty, Bursa; Department of Biology, Middle East Technical Universtiy, Ankara, Turkey

Correspondence: For correspondence or reprints contact: Lale Kostakoglu, MD, New York Hospital Cornell Medical Center, Nuclear Medicine Division, 525 East 68th Street, Starr Bldg. 221, New York, NY 10021.

ABSTRACT

Our aim was to ascertain the relationship between the degree of ^99mTc-MIBI uptake and the level of p-glycoprotein (Pgp) expression determined by flow cytometry and reverse transcription-polymerase chain reaction (RT-PCR) techniques in patients with hematologic malignancy. Methods: A total of 21 samples (19 patients) were evaluated. Two patients had repeat studies after therapy. Thirteen samples were studied at the time of initial diagnosis and 8 during relapse after therapy. After MIBI imaging, either bone marrow aspiration or peripheral blood was obtained for flow cytometric and RT-PCR analyses. Flow cytometry was performed using two different antibodies. After the injection of 555 MBq MIBI, whole-body and pelvic spot images were acquired using a dual-head gamma camera. The uptake in the bone marrow was evaluated against the background (adjacent soft tissue) by both qualitative (scoring system) and quantitative (tm/bkg ratios) analyses. Results: For flow cytometry, the limit for Pgp overexpression was set at >15% Pgp-positive mononuclear bone marrow or peripheral blood cells. There was an inverse correlation between the levels of Pgp and MIBI imaging using both the qualitative (scoring system) and quantitative (tm/bkg ratios)analyses (p = 0.022). Mean values were statistically different between Pgp + and Pgp – groups for both qualitative and quantitative analyses (p = 0.009 and 0.024, respectively). For RT-PCR, there was statistical support toward a difference in the mean values between Pgp +and Pgp – groups by qualitative analysis (p = 0.061); however, no statistical difference was found between these two groups by quantitative analysis (p = 0.179). Conclusion: Based on the strong correlation between the imaging and flow cytometry and a statistical support toward the correlation between the imaging and RT-PCR, MIBI imaging may be used for the in vivo detection of Pgp in patients with hematologic malignancy.

Key Words: multidrug resistance • p-glycoprotein • technetiurn-99m-MIBI • reverse transcription-polymerase chain reaction techniques • flow cytometry

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