Surgical Oncology 1992; 1: 391-398

Use of radiolabelled monoclonal antibodies in patients with primary and metastatic large bowel cancer S. L. SERGILE, D. G. HALLER AND J. M. DALY Divisions of Surgical Oncology and Hematology-Oncology,

the Departments of Surgery and Medicine, the University of

Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

Accurate

assessment

critical

to surgical

This prospective hand-held (B72.3)

in 28

872.3

detecting

patients

received

followed

on two

extent

external

primary

Mean

patient

and 63 years (range bowel

in six

43-77

patients

within

extrahepatic

sites.

lesions,

hepatic

sensitivity the

of 71%

external

extent

of the

external studied.

gamma

scan

in patients

(P=O.O3).

procedure

detection

primary

in 4114

did not alter gamma

the

monoclonal

antibody

primary

in 22

lesions,

localized

patients;

large bowel

primary

probe had a

sensitivity

872.3

using

influenced

immunolocalization

procedure

with external

and l/3

in l/3

gamma

a 20%

External

hepatic

disease

with

years)

in the large

patients.

l/7

125iodine-labelled operative

received 2-3 weeks

60 years (range 28-75

sites were

compared (29%)

detector/camera patients

probe evaluation

primary

probe

antibody Fourteen

gamma

as metastatic

to detect scanning

cancer.

is

cancer.

Fourteen

probe at operation

compared

and metastatic

monoclonal

sites. The intraoperative

of metastases

was more sensitive

with

gamma

method

Disease

cancer

information.

and an intraoperative

bowel

an external

in l/5

and 3/3 extrahepatic

Thus, using a hand-held

lz5iodine-B72.3

large

by intraoperative

as well

intraoperative

operative

images

injection.

bowel

prognostic

“‘indium-labelled

scan with

uptake

for detection

gamma

camera

metastatic

respectively.

primary

large

reliable

ages for the two groups were years),

and

The

metastatic

of radiolabelled

7 days after

followed

“‘indium-B72.3

detected 7/11

and

body imaging

24 h apart

1.0 mg (2.0 mCi) ‘?odine-B72.3

scanning

gamma

probe for detection

with

by whole

and

and to providing

0.2 to 20 mg (2 or 5 mCi)

occasions

postinjection.

of primary

making

study compared

gamma

patients

of the

decision

Surgical

in the

the with

14 patients

tumour

uptake

of

for “‘indium-B72.3 Oncology

1992; 1:

391-398. Keywords:

colorectal

cancer,

metastases,

monoclonal

antibodies.

of the extent and location of primary,

INTRODUCTION

metastatic Optimum with

patient management

large

bowel

reproducible

staging

priate treatment

cancer

accurate

tests and procedures.

depends

some

decisions for patients require

instances

Current

and

tumour to allow complete to decrease

standard

methods

the extent to detect

disease beyond physical examination

Appro-

nuclear

on accurate determination

and

magnetic

recurrent

imaging,

and

resection or in of surgery.

the extent

of

include X-ray, ultrasound

and

ultimately surgical exploration. Correspondence:

John M. Daly, MD, Department

Hospital

University

of the

of Pennsylvania,

Tumour

of Surgery, 3400

Spruce

clonal

Street, 4 Silverstein, Philadelphia, PA 19104, USA. Supported

in part by the Georgene

Fund and grants from

Cytogen

S. Harmelin

Corp.,

Princeton,

antigens to

Researcl,

localization

antibodies

NJ and

external 391

radiolabelled at

methods

gamma

of

mono-

tumour-associated

has been found to be an effective

standard

staging. Tumour

Neoprobe Corp., Columbus, OH, USA.

using

directed

tumour

addition

detection

and

localization has been achieved with scans [I -41.

However,

significant

S.L. Sergile et al.

392 blood pool background, restricted gamma

the

scan images

limitations, probe

an

(GDP)

antibody

and

uptake

of

[3, 41. To circumvent

(Neoprobe

termed

in the liver, has

specificity

intraoperative

OH) was developed nique

especially

sensitivity

gamma

the

these

detecting

Corporation,

Columbus,

to localize ‘25iodine-labelled

in tumour

at laparotomy,

radioimmunoguided

(‘251)

a tech-

surgery

(RIGS)

enhanced ance

significant

IgG, which

antibody

(MoAb)

872.3

is a murine

reacts against a high molecular

mutinous

glycoprotein

termed

associated

glycoprotein).

TAG-72

872.3

weight (tumour-

has been found to

be reactive against several mucin-producing carcinomas, mas,

including

with

most

substantially

tissue

[7].

cancer

have

and

been

detected

probe

during

adenocarcino-

reactivity

metastatic

using

surgery

to

normal

large

bowel

using both “‘indium-

872.3 with external

251-labelled B72.3

methods

less

Primary

labelled (“‘In)

colonic

adeno-

gamma

scanning

a hand-held

[8,

91.

gamma

However,

have not been compared

these

within the same

institution.

tive

studies

approved tional

were

done in the same

effectiveness graphy

prospective

institution

of “‘In-labelled

to compare

B72.3

and ‘251-labelled B72.3

trials the

immunoscinti-

radioimmunoguided

reson-

roentgenograms

were

using

disease. These prospec-

monoclonal

by the University

Review

Board

patients with

antibodies

were

of Pennsylvania

and all eligible

Institu-

patients

pro-

patients were studied with “‘In-labelled

B72.3 (Cytogen gamma

Corp., Princeton,

detection.

NJ) using external

Each patient

received

a single

dose of either 0.2, 0.5, 1.0, or 2.0 mg 872.3 labelled with

4-5

over

5-l 0 minutes.

using

mCi of “‘In

the

administered “‘In-B72.3

carbohydrate

intravenously

was

linker

radiolabelled

specific

technique

of glycyl-tyrosyl-diethylenetriaminepentaacetic (GYK-DTPA) referred

[I 01. The B72.3-GYK-DTPA

to as CYT-103.

closely

acid

conjugate

Vital signs were

is

followed

prior to and for 3 h after initiation

of the

infusion. Gamma

camera

scans were

occasions prior to operation views

after

“‘In-B72.3

were

gamma

performed

infusion.

obtained

on two

at least 24 h apart up to

with

a

Multiple

camera with a parallel hole medium

colimator

(GE2000,

IGE Medical

planar

large-field-of-view Systems,

energy

Hertford-

shire, UK) placed on or as close to the body surface

surgery to localize primary, recurrent and metastatic

as possible.

large bowel cancer and to evaluate the clinical value

both “‘In

these methods

of 1,000,000

may add to decision

scans, magnetic

vided written consent.

7 days

In this study, two semi-parallel

chest

extra-abdominal

Fourteen

Monoclonal

and

carried out for staging and to exclude

[5-61.

and

and portography)

images

making during

surgical procedures.

the

Energy

settings

were

callibrated

for

photon peaks (173 and 247 keV). Images

pelvis,

counts

per view

abdomen,

and

were

collected

thorax

in the

over

anterior

and posterior position. The scans were examined MATERIALS

AND

Nuclear

METHODS

Medicine

staff physicians.

for the “‘In-B72.3 Twenty-eight

patients

diagnosed

suspected or documented bowel

adenocarcinoma

parallel prospective neoplastic

therapy

immunotherapy) clonal antibody mouse

sampling

appropriate bowel enemas,

studied

anti-

radiation

or

to murine

No patient had pre-

antibodies,

severe

iodine colonic

allergies

reactions, lesions

to or

requiring

procedures. standard

imaging,

procedures Colonoscopies,

computed

were

diagnostic

and

performed

as

and staging

of large

air-contrast

barium

tomography

(unenhanced,

laparotomy

parietal

complete

peritoneal

gastrointestinal

tract

cally or by preoperative and

the

approxiinfusion.

liver, kidney, and

lymph

pancreas

nodes

was

to be tumour clini-

staging studies was docu-

tissue

suspicious

antibody

inspection of all visceral and

surfaces,

carried out. All tissue suspected mented

distinct from

was performed

7 days after monoclonal

At operation, and

accumulation

uptake in blood, heart, liver and kidney.

Each patient’s mately

A positive result

external gamma scan was defined

as a focal area of “‘In background

biopsied;

for the diagnosis

cancer.

large

in two semireceived

(chemotherapy,

symptomatic

Preoperatively, tissue

were

trials. No patient

administration.

proteins,

urgent operative

primary,

for at least 3 weeks prior to mono-

vious exposure obstructing

with

recurrent metastatic

by

was

areas

either

defined

removed

or

by scan were

also removed or biopsied. Fourteen injection

patients and

were

using the hand-held days

prior

to

received

an ‘251-labelled B72.3

examined gamma

radiolabelled

intraoperatively

detecting antibody

probe. Two injection,

393

Radiolabelled MoAb and colon cancer detection patients

were

potassium

given

a supersaturated

solution

iodine (SSKI, 10 gtts day-‘)

of operation to inhibit radiolabelled the thyroid.

Skin testing

with

of

until the day

iodine uptake by

unlabelled

antibody

vitro well scintillation. specimens TAG-72

were

antigen

Tissue sections from surgical

evaluated

for

expression

the

presence

of

by immunoperoxidase

staining.

(0.1 mg in 0.1 ml of sodium chloride) was performed 24 h before injection of the radiolabelled detect allergic reactions. tive skin test were clonal

antibody,

probe

Corp.,

received

a single dose

intravenously for

At operation,

explored probe

with

Each

patient

mCi) of lz51-B72.3 after

opera-

injection

background

and

to

optimal

underwent

as described

The

the

hand-held

a thorough

above and find-

abdomen

(Neoprobe,

was

then

gamma

Neoprobe

re-

detecting

Corporation,

OH). The GDP is an 18 cm long stain-

less steel tube with a moveable cadium

transmits

signal through a preamplifier

radioactivity

telluride

collimator.

sensitive

digital readout

As shown

in Table 1, 28 patients were studied;

patients

underwent

monoclonal years

A radio-

crystal at the probe’s tip

and an auditory

is ‘squelched’

to produce a

signal. Background

by placing

the

probe

(range

count.

The signal

at twice

intensity

varies directly with the gamma 2:l

ratio is considered

this back-

and frequency

photon counts. The

to be the threshold

the audio signal in the tumour

at which

is significantly

differ-

metastases

tumour scanning

as shown

equivocal

triplicate.

A tumour-to-normal

than 2:l

with probe counts greater

per 2 set tissue

was

thought

tive gamma in-situ residual

as a positive tumour

result.

either

All

of

surgical

the

radioactivity.

subsequently

resection

hand-held All

to

in-situ

and examined

then detect

margins patho-

logically. tumour ex

studied

histopathological

and normal tissue specimens with

the

gamma

mixed

had only hepatic metastases. accumulation

viously photopenic

patients

tumour in faeces.

had

or excreted Six patients

Within the total group

of “‘ln

uptake

one patient at a pre-

site 7 days post-injection.

patients involving

Table

had

extrahepatic,

the ovary

Three

metastatic

and paraaortic

lymph

1. Patient characteristics

“‘In (872.3)

probe

lz51(872.3)

Number

14

14

Age (years)

60 (28-75)

63 (43-77)

Male/female

1 o/4

analysis,

were counted in the

lz51-872.3 and in both groups

patients with

in

618

Disease sites (by organ) 5

3

7

11

Lymph node

1

1

Ovary

1

1

Pelvic sidewall

0

1

Lung

1

0

Primary RecurrenUmetastatic: Extrahepatic

vivo with

Two

monoclonal

scan with focal uptake in the

by clini-

were

probe

positive

resected

In addition to standard

uptake.

colonic antibody

or by a posi-

count was then resected or biopsied. All using

2. Two

to be either

material

and syn-

One primary

of seven patients with liver involvement,

than 20 counts

at the first exploration

margins

surveyed

mono-

tissue ratio of greater

to contain

cat judgement

were

recorded

in

colon tumour

using monoclonal

no focal

thought

disease

for 2 set

years).

scans or at operation.

in Table

monoclonal

had focal

detector

six men and eight

of hepatic or extrahepatic

metastases.

identified

scans showed

gamma

14

tissue

with “‘ln-labelled

had a primary

was

remaining

scanning, four patients had primary

hepatic

additional

counted

age of these

on preoperative

One patient chronous

normal

tissue were

The

with a hand-held

tumours with no evidence

ent than normal tissue [12]. All obvious tumour and adjacent

years).

lz51-B72.3 and intraoperative

In the group evaluated clonal antibody

radiolabelled

only

studies. The 10 men

women was 63 years (range 43-77

rectum

ground

28-75

patients received

duce

signal

imaging

14

‘l’ln-labelled

in this group had a mean age of 60

counts obtained

over the aorta and then adjusting the probe to proan auditory

preoperative

antibody

and four women

probe. The mean

all patients

using (GDP)

days

[12].

noted.

Columbus,

[I I].

(1 mg/2

blood

exploration

were

OH)

of 21 +4

tumour detection

ings

radiolabelled

over 5 min. Patients underwent

a low

abdominal

was

Columbus,

RESULTS

into the study. Mono-

using the lodo-Gen method (Neo-

tion an average allow

entered B72.3

sodium iodide-125

antibody to

Only patients with a nega-

liver

disease

394

S. L. Sergile et al. of “‘In-B72.3

Table 2. Sensitivity

of “‘In-872.3

Table 3. Sensitivity

with external gamma

with external gamma

camera scanning and 1251-B72.3 with internal gamma

camera scan and lz51-B72.3 with internal gamma

detection to identify metastatic

to identify metastatic

colorectal

cancer by

colorectal

detection

cancer

tumour site “‘In (872.3)

lz51(872.3)

Organ sites*

n=15

n=17

True positive

3 (20%)

12 (71%)

Tumour site

“‘In (B72.3)

‘=I (672.3)

Primary

n=5

n=3

True positive

1

1

False positive

1 (6%)

False negative*

4

2

False positive

0

0

n=7

n=ll

True positive

1

8

False negative

6

3

False positive

0

0

Liver metastases

*Confirmed

one

2 (13%)

by histopathology.

patient

had

significant

lz51 uptake

in synchro-

n= 3

n=3

nous liver metastases.

True positive

1

3

rent or metastatic

False negative

2

0

was localized in eight of 11 patients. Three patients

False positive

1

2

also had extrahepatic

disease: all sites

Extrahepatic

Lymph node True positive

0

2

False negative

1

0

False positive

0

2

Of the 11 patients with recur-

hepatic

disease,

disease which was identified

including lymph nodes (common aortic

node),

ovary

the malignancy

and the

bile duct and para-

pelvic

sidewall.

Two

episodes of false positive 1251uptake occurred.

Both

patients had lymph nodes suspicious for disease by

Ovary True positive

1

1

clinical

False negative

0

0

plasia without tumour was noted microscopically.

False positive

0

0

inspection,

but

reactive

lymphoid

hyper-

Pelvic sidewall True positive

0

1

False negative

0

0

False positive

0

0

TAG-72 antigen Tissue

specimens

expression *Includes

two equivocal scans.

expression for

had a comparable

with radiolabelled externat

studied

TAG-72

positive

correlation

B72.3 uptake whether

gamma

scan or internal

antigen

detected

gamma

by

detection

(Tables 4 and 5). Ten tissue sections from patients Only one patient

nodes. ized scan.

using

the

An apparent

lumbar

positive by antibody radiographically As shown

had the ovarian

preoperative

lesion

monoclonal

vertebral

imaging

local-

nuclear

focus deemed

was not corroborated

or clinically 8 months after imaging.

in Table 3, the overall true-positive

rate

studied with “‘In were tested for TAG-72 expression (Table 4). One of two tissue sections that showed antibody tumour tissue with

uptake by gamma by

pathology

sections

tested

monoclonal

scan and demonstrated

was

TAG-72

positive.

had a false-negative

gamma

scan.

Three

Six result

of

the

6

for 15 sites in 14 patients was 20%. External gamma

sections had no TAG-72 expression

scan sensitivity

sections were TAG-72 positive. Tissue sections from

was not affected

dose administered

by the “‘In-B72.3

(Table 4).

two

As shown in Table 2, three patients with primary

patients

with

tumours and 11 patients with recurrent or metastatic

dose external

tumours

Sixteen

872.3

underwent

evaluation

and the intraoperative

using

hand-held

1251-labelled probe. One

equivocal

positive. No correlation

scans

were

scan results and TAG-72

assayed

TAG-72

was found among “‘in-B72.3

tissue sections

lz51 were

and three tissue

from

for TAG-72

patients

expression. studied

expression

with

(Table 6).

of three patients had their primary tumour localized

Eight of 12 tumour

using the intraoperative

clonal antibody uptake also showed TAG-72 expres-

had clinically showing

suspicious

increased

technique.

mesenteric

radioactivity

but the nodes were

negative

logical examination.

No increased

detected

This patient also over

lymph

nodes

background,

for tumour

at patho-

radioactivity

was

in the other two primary tumours although

sion.

Four

expression

tissue

specimens sections

that

had positive monoclonal

detected with the hand-held tive

with detected

correlation

immunolabelled

had

no

monoTAG-72

antibody uptake

probe. The overall posi-

between

TAG-72

expression

antibody

uptake

as detected

and by

395

Radiolabelled MoAb and colon cancer detection Table 4. “‘In radiolabelled

B72.3

Patient

detected with external camera and TAG-72 antigen expression

Dose “‘In-B72.3

Site

Scan

Pathology

TAG-72

(mg/mCi)

in tissue

section

1

214.9

Primary

-

+

Not done

2

0.5/4.3

Primary

-

Not detected

3

0.5/4.0

Primary

4

0.2/2

Liver

5

0.2/2

Ovary

6

0.212

Liver

7

0.212

Primary

8

0.2/2

Liver

9

0.2/2

Liver

212

Liver

Liver

+ -

+ + + + + + + + + + + + +

Primary

lb

+

using

the

Liver

IO

f + + + -

11

20/5

Lymph node

12

2015

Lung

-

Lumbar spine 13

215

14

2015

5% 50% Not detected Not detected 10% 50% Not done Not done Not detected Not done 5% Not detected Not done 10%

Table 5. TAG-72 antigen expression in tissue section

radioactive

compared

margins after tumour adherent to the pelvic sidewall

with radiolabelled

Tissue sections True positive* TAG-72

positive

TAG-72

negative

False negative* TAG-72

negative

TAG-72

positive

Positive correlation * Radiolabelled

872.3 detection

“‘In (872.3)

lz51 (B72.3)

n=lO n=l 3 0 n=7 4 3 7110 (70%)

n=17 n=12 8 4 n=5 3 2 11/I 7 (66%)

was

uptake

resected.

Re-excised

detection.

gamma

margins

at

surgical

revealed

areas

positive for tumour and further surgical excision was done. patient

Hepatic who

resection

which demonstrated section

activity

analysis

colon cancer.

metastases

scan or internal

probe

abandoned

increased

pathologic

metastatic

was

had slight enlargement

in one

of one ovary

radioactivity; was

frozen

consistent

One patient

with

with

hepatic

was also found to have increased

in clinically

non-suspicious

radio-

mesenteric

and

hepatoduodenal

lymph nodes. Frozen section patho-

logical

confirmed

analysis

altered the operative external

probe

metastatic

disease

and

management.

was 40%

and 66%, respectively. DISCUSSION Influence

of monoclonal

antibody

scanning

on

Approximately

treatment Use of “‘In-B72.3 tively provided with

results

staging

or

and external

no additional noted

on

intraoperative

patients studied. In 4/14 the lz51-872.3 antibody, was

suspicious and

the

increased.

altered.

scanning

information

routine

extent One

of

the

(29%) patients studied with

mesenteric

patient

clinically

non-

radioactivity

disease at the time of presenta-

tion [I 1, 131. Complete

surgical

resection

of large

bowel cancer offers the only potential cure for both primary and recurrent tumours,

making the accurate

diagnosis of tumour extent and location essential to optimal

treatment.

Knowledge

of extensive

meta-

static disease would also preclude a more extensive operative

was

The

increased

nodes

resectoin

demonstrated

bowel

and nearly 50% of these patients will have obvious

regarding

lymph nodes had increased

of large

or occult metastatic

disease in the fourteen

patient,

cases

preopera-

the type and extent of treat-

In one

new

each year in the United States

compared

roentgenographic

findings

extent of primary metastatic

ment

155,000

cancer are diagnosed

procedure

presence is

the

of

and perhaps lessen morbidity. metastatic

strongest

spread

prognostic

to

lymph

indicator

of

S. L. Sergiie et al.

396

Patient

Site

Probe

Pathology

TAG-72

Table 6. lz51 radiolabelled

872.3

detected

gamma

by intraoperative

detection 1

Liver

5%

Primary

+ -

+

2

+

Not done 20%

antiexpression

Proximal margin

-

+

Liver

+

+

Not detected

Liver

+

80%

Lymph node (celiac)

+

+ -

4

Liver

+

+

50%

Liver

+

+

50%

5

Liver

+

+

10%

Liver

+

+

50% Not done

3

Pelvic sidewall

+

+

+ -

+

Not done

+

Not done

Primary

7 8

Liver

-

+

Not done

9

Liver

+ _

+

Not detected

Liver

10

+

Not detected

+

Not detected

11

liver

+ -

+

50%

12

Liver

+

+

Not done

Lymph node (CBD)

+

+

80%

Lymph node (paraaortic)

+

+

Not done

Liver

+

+

33%

Primary

+

Lymph node (mesentery)

+

+ -

Not done

Ovary

13 14

loco-regional

recurrence

of lymphatic

ever, is difficult. only 71%

Gross tissue examination

sensitive

nodal metastases node metastases less than

1171. In addition,

how-

alone is

in identifying 64%

of lymph

are found in nodes that measure

5 mm

in diameter

majority of metastases clinical examination, be developed

66% accurate

and

Not detected

161. Clinical diagnosis

[15,

disease at the time of operation,

[18].

Because

the

are beyond the resolution of

new diagnostic

to identify

methods

micrometastases

must

in order

to plan optimal therapies. The

liver

metastatic

is the

from

common large

distant

bowel

hepatic

tumour

diagnosis

metastases, beyond detect

metastases only

5 years

[19].

at the time After

[20-221.

occult extrahepatic

the growing

synchro-

of hepatic

patients

Diagnostic malignancy

use of aggressive

to tumour recurrence

of

with

of primary

resection

20 to 30%

site of

cancer

many patients having potentially resectable nous

survive

modalities

to

must match

surgical approaches

in order to assure appropriate

external

prolonged

[24,

high blood-pool

venous administration

251.

that

gamma

labelled

to

after intra[3]. Maguire

with “‘In

identified

tumour sites in the pelvis, 55% in

the liver, and 70% at other sites [26]. Identification of occult tumour affected

surgical treatment

of patients. A large multicentre with

external

gamma

sensitivity

of

20%.

hepatic metastases “‘In accumulatian

Prior

in 72%

trial using “‘In-B72.3

detection

found

studies

as photophenic

comparable

had an overall have

reported

defects, areas of

or both [27]. Unlike these reports,

we did not report test results as positive for hepatic metastases photophenic positive

that appeared hepatic

results,

as photopenic

defects

this test

areas.

If

had been considered

would

have

sensitive. The failure of liver metastases

been

47%

to accumu-

late antibody has been attributed to tumour differentiation, mucin content,

and central necrosis as well

‘3’l-fabelled

B72.3

cially

localized

low

attributed

background

as the large uptake of “‘In

scanning

However,

were

of the antibody

et al. found that 872.3 69% of colorectal

[2]. Diffuse

et a/. showed by

cancer

resec-

tion of all disease. detected

colon

rates (46% sensitivity)

complete

patient selection who can undergo Clocher

metastatic detection

results [8]. In our study, “‘In-B72.3

most

disease

in tissue section

Not detected

Coccyx margin

6

and TAG-722186X

also

radioactivity

in the transverse been

described

by hepatic Kupffer cells

in the large bowel, or descending with

“‘In-labelled

colon,

espehas

anti-CEA

397

Radiolabelled MoAb and colon cancer detection monoclonal

antibody

291. Some

and “‘In-labelled

investigators

to imaging to reduce this confounding lmmunolocalization

with

ning or single photon ing

(SPECT)

clearance

is

and

B72.3 [4, 28,

have used cathartics

hindered

years.

Major

study

in two

tomographic

imag-

extrahepatic

slow

blood-pool

accumulation

of “‘In-

in the liver [3, 41. The hand-held

detector

probe

gamma-emitting minimizes external

designed

to detect

radioisotope

background scanning

gamma the weak

lz51 [6]. This technique

interference

found

in which detection

with

is constrained

As

and probe.

groups was 83%,

scan-

antibody

was

by clinical examination

variable [4].

by

non-specific

mined

for the three

gamma

external

emission

prior

hepatic

resection

patients

30%

was avoided

based

more

selective

tumour detection

antibodies

are

developed,

by either method of immunolocali-

zation should improve.

New monoclonal

antibodies

with greater affinity for large bowel cancer are being developed.

et al. found that the anti-CEA

Dawson

monoclonal

antibody

(A5B7)

localized

98.7%

tion about

decreases from

and may become

background

counts.

gamma detecting to potential

the

count

rate

too low to distinguish Because

the

hand-held

probe can come into close contact

tumour

sites, a low tumour-to-normal

tissue ratio of radioactivity

may be detected

[30].

71%

for detection

bowel

tumours

multicentre

of primary

which

and metastatic

large

surgery

WI. The

ultimate

goal

driving either

the

development

with

probe

is to obtain

impact

unique

upon patient

B72.3

with

camera

gamma

detector

scanning

effect on the treatment Other

series

information

management.

external have

of

gamma

scanning or with the intraoperative

which

will

Results of “‘ln-

had no appreciable

undergoing

operative

procedure

high affinity

second-look

ogy influenced Santanello altered

treatment

gamma

treatment

modified

detector

monoclonal

in 29% of patients. Sickle-

treatment

resection

to improve

in 26% of patients with

suggests

may

further

hepatic

[22].

improve

reseaction

rule

out

predicted

patient

selection

for

and help to improve

extrahepatic

long-term

a second-look

disease

surgery

examination

examination

and

probe,

major

evaluation

combined

with

accurately undergoing

[31]. Patients were

in one of three groups: resectable clinical

particularly

lllln-labelled

that

antigen

High

affinity

to detect

abdominal

monoclonal

even greater detecting

[33]. of

detector

occult colorectal recurrences, gamma

antibodies

than

scanning.

may

lead

to

clinical utility of immunolocalization

large

appropriate

puri-

may also

immunolocalization

B72.3 using external

bowel

cancer

and

in

directing

its

treatment.

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