Combined diagnostic imaging with 131I-metaiodobenzylguanidine and 111In-pentetreotide in carcinoid tumours

doi:10.1016/0959-8049(96)00241-9

European Journal of Cancer

Volume 32, Issue 11, October 1996, Pages 1924-1932

https://doi.org/10.1016/0959-8049(96)00241-9 Get rights and content

Abstract

Carcinoid tumours derived from the neural crest are usually associated with the symptoms of flushing and diarrhoea in the presence of liver metastases. Scintigraphs with ¹³¹I-metaiodobenzylguanidine (¹³¹I-MIBG) which is accumulated in the argentaffin granules of the cell, as well as with ¹¹¹In-pentetreotide for the imaging of somatostatin receptors on the cell surface, are positive in a large proportion of carcinoid patients. To evaluate the complementary role of both radionuclide tests, we studied 20 consecutive carcinoid patients: 14 with the characteristic carcinoid syndrome and 6 with tumour symptoms, such as pain or obstruction. A positive test was found in 84% with either ¹³¹I-MIBG or ¹¹¹In-pentetreotide; the combination yielded a sensitivity of 95%. A positive correlation was found with the presence of the carcinoid syndrome, but not with 5-HIAA excretion. A positive test may help in adjusting treatment: either to predict the response to octreotide or to select patients for ¹³¹I-labelled MIBG treatment. Application of a therapeutic dose of ¹¹¹In-pentetreotide may be limited by the high normal uptake in the kidneys.

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An alternative to Octreoscan is metaiodobenzylguanidine (MIBG) scintigraphy, a norepinephrine analogue that makes use of the reuptake mechanism to gain entry into catecholamine storage vesicles of carcinoid tumours to localize it. Although the reported sensitivity of this test was low, recent data showed that the combination of MIBG and Octreoscan had a promising positivity of 95%47. Patients should avoid stress and avoid substances that may precipitate symptoms such as alcohol, spicy food, tryptophan-rich food1.
Carcinoid syndrome, a paraneoplastic condition linked with the release of multiple humoral factors, affects around 30-40% of patients with well-differentiated neuroendocrine tumours. Carcinoid syndrome has a major and unfavourable impact on patients' quality of life; it raises costs when compared to non-functioning neuroendocrine tumours; and it causes patients' lifestyles to alter, such as food, job, physical activity, and social life. Somatostatin analogues have been the first-line therapy for individuals with neuroendocrine tumours and carcinoid disease for decades. While these drugs give considerable relief from carcinoid syndrome symptoms, clinical progression is unavoidable, necessitating further research into newer treatment measures.
Carcinoid tumours are sometimes difficult to diagnose because of their vague or nonspecific symptoms. There have been several advancements in all aspects of carcinoid syndrome, as well as novel therapeutics, in the previous few years. New epidemiological studies show that it is becoming more common; increasing insights into the pathogenesis of its various clinical manifestations and its natural history: definition of prognostic factors; new methods to verify its presence; the development of new drugs to treat its various manifestations, both initially and in somatostatin-refractory cases; and an increased understanding of the pathogenesis, natural history, and management of the disease.
An all language literature search was conducted on MEDLINE, COCHRANE, EMBASE, and Google Scholar till November 2021. The following search strings and Medical Subject Headings (MeSH) terms were used: “Recent advances”, “Carcinoid syndrome”, “Neuroendocrine Neoplasms” and “Carcinoid heart disease”. We comprehensively reviewed the literature on the pathogenesis, clinical features, and newer treatment modalities for Carcinoid Syndrome.
Recent advancements in research and management have resulted from advances in our understanding of the aetiology of carcinoid syndrome. The development of molecular indicators of aggressiveness improved serum tumour markers, and the molecular aetiology of carcinoid heart disease are all possible because of advances in molecular biology. We conducted a comprehensive review to update knowledge regarding the pathophysiology, diagnostic protocols, and current and newer treatments for carcinoid syndrome, which presently requires a multidisciplinary approach, due to the complexity of the illness's aetiology, diagnosis, and therapy.
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Median PFS observed in our study is encouraging for PC patients. Patients with functioning tumours and slowly progressive disease treated with SSAs have better prognosis.
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In carcinoids, Modlin and colleagues39 reported a 50% median detection rate and 76% sensitivity of mIBG scintigraphy; whereas a sensitivity of 84% has been shown for SRS.40 However, mIBG can also show some uptake in nonoctreotide-avid lesions,41 and it could play a complementary role in NET imaging, because its use in combination with SRS has been shown to increase sensitivity up to 95%.42 Moreover, in 1 study, different metastases in the same patient were found with differential mIBG and SS analogue uptake.43
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^∗: B.G. Taal at Antoni van Leeuwenhoekhuis, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.

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Original paperCombined diagnostic imaging with 131I-metaiodobenzylguanidine and 111In-pentetreotide in carcinoid tumours

Abstract

Carcinoid tumours

Scintigraphic imaging of carcinoid tumours with 131I-metaiodobenzylguanidine

Lancet

Diagnosis and treatment of a carcinoid tumor using iodine-131 metaiodobenzylguanidine

Clin Nucl Mad

Iodine 131 metaiodobenzylguanidine scintigraphy of carcinoid tumors

J Nucl Med

The use of 131I-MIBG in the imaging of metastatic carcinoid tumours

Br J Cancer

Role of 131I-metaiodobenzylguanidine therapy in carcinoids

J Nucl Biol Med

Original paper
Combined diagnostic imaging with ¹³¹I-metaiodobenzylguanidine and ¹¹¹In-pentetreotide in carcinoid tumours

Scintigraphic imaging of carcinoid tumours with ¹³¹I-metaiodobenzylguanidine

The use of ¹³¹I-MIBG in the imaging of metastatic carcinoid tumours

Role of ¹³¹I-metaiodobenzylguanidine therapy in carcinoids