The radioguided 111 In-pentetreotide surgery in the management of ACTH-secreting bronchial carcinoid

V. Porziella 1, A. Cesario 2, F. Lococo 1, S. Cafarotti 1, S. Margaritora 1, G. D’Errico 3, P. Granone 1

1 Division of General Thoracic Surgery, School of Medicine, Catholic University of the Sacred Heart, Rome (Italy) 2 IRCCS San Raffaele Pisana, Rome (Italy) 3 Nuclear Medicine Institute, School of Medicine, Catholic University of the Sacred Heart, Rome (Italy)

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• Nuclear Medicine

Background and Objectives: A correct intra-operative detection of the tumour and, therefore, the complete surgical resection is critical to success in ACTH-secreting bronchial carcinoids. To date, all available pre-operative and intra-operative procedures remain not entirely satisfactory. The use of intra-operative 111 In-pentetreotide detection could offer a potentially reliable and rapid tool of real time assessment to achieve a radical resection.

Materials and Methods: In two cases of ACTH-secreting bronchial carcinoids, after a preliminary 111 In-pentetreotide scan, radio-guided surgery was performed using a hand-held gamma probe 24 h after i.v. administration of the tracer.

Results: The 111 In-pentetreotide radioguided surgery with hand-held gamma probe, if compared with pre-operative 111 In-pentetreotide, significantly improved the intra-operative surgical management by detecting a millimetric nodule in one case; detecting mediastinal lymph node metastasis in both cases and ruling out any other disease localization.

Discussion: Intra-operative 111 In-pentetreotide detection appears to be safe and easy to perform. This technique allowed to achieve a complete resection of all the tumor locations, that would have been impossible to detect with conventional surgical approach.
On the basis of these results we advocate for a wider investigation of the potentialities connected with the radioguided surgery coupled with pre-operative 111 In-pentetreotide scan as a promising procedure in the management of ACTH-secreting bronchial carcinoids.

Corresponding Author: Lococo Filippo, MD; e-mail: filippo_lococo@yahoo.it