¹³¹I ovarian uptake in a whole-body scan for thyroid carcinoma

The whole body 131-I scan remains an important component in the postoperative treatment of patients with well-differentiated thyroid cancer. Because normal thyroid tissue remnants and residual or metastatic foci of well-differentiated thyroid cancer have the unique ability to concentrate, organify, and store 131-I, the whole body scan provides a depiction of those tissues that can be ablated with therapeutic doses of 131-I. Over time, it has become obvious that the whole body scan may also reveal foci of 131-I uptake owing to a wide variety of other causes. We provide a detailed pathophysiological classification of the artifacts, anatomic and physiological variants, and nonthyroidal diseases that may give rise to falsepositive whole body scans in postoperative patients with thyroid cancer. These include ectopic foci of normal thyroid tissue; nonthyroidal physiological sites (eg, choroid plexus, salivary glands, gastric mucosa, urinary tract); contamination by physiological sections; ectopic gastric mucosa; other gastrointestinal abnormalities; urinary tract abnormalities; mammary abnormalities; serous cavities and cysts; inflammation and infection; nonthyroidal neoplasms; and currently unexplained causes. This article also provides a detailed review of the widely scattered English language literature in which these phenomena were originally described.

Forty-eight cases subjected to radioimmunoimaging (RII) by intraperitoneal injection with ¹³¹I-C0C183B2 monoclonal antibody (MAb) prepared in our laboratory were studied. Thirteen of 14 cases of proved primary ovarian carcinoma were positive. In 11 follow-up cases of ovarian carcinoma after initial surgery and chemotherapy, 5 recurrences were positive and 6 cases without recurrence were negative; all were confirmed histopathologically after a second operation. One false negative was ovarian mucinous adenocarcinoma, which also negatively stained with C0C183B2 by the peroxidase anti-peroxidase method. Twenty of 23 cases of nonepithelial or metastatic carcinoma of the ovary, benign tumors, and benign diseases were negative. The sensitivity and specificity were 94.7 and 89.7%, respectively. If patients had complications with ascites, the MAb which positively stained with the cancer cells in the ascites was chosen for RII. For follow-up cases PAP staining with the tumor tissue from the initial surgery and the MAb should be done before RII. These are the principal factors that increase the positive rate and accuracy of RII. The intraperitoneal route seems to be a valuable method for clinical staging and tumor localization as well as for follow-up use.