Stellenwert der Radioimmunszintigraphie in der Diagnostik und Verlaufskontrolle des Ovarialkarzinoms im Vergleich zur Computertomographie und Second Look-Operation

Zusammenfassung

Die Szintigraphie mit radioaktiv markierten Antikörpern findet zunehmend Anwendung bei verschiedenen Tumoren. In der vorliegenden prospektiven Studie werden die Grundzüge der Radioimmunoassay (RIS) und ihre Wertigkeit in der Diagnostik und Verlaufskontrolle des Ovarialkarzinoms im Vergleich zur Computertomographie (CT) und zur Second Look-Operation anhand von 27 Patientinnen (Primärdiagnostik) und 52 Patientinnen (Verlaufskontrolle und Re-Staging nach chirurgischer und Chemotherapie) dargestellt. Die Ergebnisse werden mit der Immunhistochemie und dem CA125-Serum-Spiegel verglichen. Wir fanden in der Primärdiagnostik eine Sensitivität für die RIS von 100% bei einer Spezifität von 60%, in der Rezidivdiagnostik von 75% bzw. 68%. Es zeigte sich, daß die RIS besonders zum Nachweis der Peritonealkarzinose gegenüber der CT eine höhere Sensitivität besitzt bei geringerer Sensitivität für Organmetastasen. Dennoch können CT und RIS die »Second Look«-Operation nicht ersetzen.

Summary

In this prospective study the diagnostic capability of radioimmunoscintigraphy (RIS) was compared with that of computed tomography (CT) and of “second look” surgery as primary diagnostic procedures in 27 patients and in the follow- up of 52 women suspected of suffering from ovarian cancer. The results were compared with immunohistochemical findings and CA125 serum levels. For primary diagnosis sensitivity, specificity and diagnostic accuracy of RIS was 100%, 60% and 90%, resp. In follow-up, sensitivity for local recurrencies was 75% and specificity 68%. Peritoneal carcinosis in the pelvis and lower abdominal region was better detectable by RIS, but for detection of liver metastases CT showed better results. CT and RIS could not replace “second look” surgery.

Schlüsselwörter

Radioimmunszintigraphie - OC125 - Ovarialkarzinom

Key words

Radioimmunoscintigraphy - OC125 - ovarial carcinoma

• LITERATUR

• 1 Aure JC, Hoeg K, Kolsted P. Clinical and histological studies in ovarian carcinoma. Long-term follow-up of 990 cases. Obst Gynecol 1977; 37: 1-9.
• 2 Bagley CM, Young RC, Schein PS, Chabner BA, De Vita VT. Ovarian carcinoma metastatic to the diaphragm: frequently undiagnosed at laparatomy – a preliminary report. Am J Obst Gynecol 1973; 116: 397-400.
• 3 Barzen G, Mayr AC, Langer M. et al. Radioimmunoscintigraphy of ovarian cancer with ¹³¹iodine labeled OC-125 antibody fragments. Eur J Nucl Med 1989; 15: 42-8.
• 4 Bast RC, Feeney M, Lazarus H. et al. Reactivity of a monoclonal antibody with human ovarian carcinoma. J Clin Invest 1981; 68: 1331-7.
• 5 Baum RP, Maul FD, Senekowitsch S. et al. Radioimmunoscintigraphy and radioimmunotherapy with monoclonal antibodies (19-9/anti-CEA and OC-125). In: Radioaktive Isotope in Klinik und Forschung. Höfer R, Bergmann H. Hrsg. 1986; 17: 443-7.
• 6 Berek JS, Knapp RC, Malkasian GD. et al. CA125 serum levels correlated with second look operations among ovarian cancer patients. J Obst Gynecol 1986; 67: 685-9.
• 7 Breit A, Rhode U. Computertomographie gynäkologischer Tumoren. Stuttgart - New York: Thieme; 1981: 54-7.
• 8 Brenner DE, Shaff MI, Jones HW. et al. Abdominopelvic computed tomography: evaluation in patients undergoing second- look laparatomy for ovarian carcinoma. Obst Gynecol 1985; 65: 715-9.
• 9 Buy JN, Moss AA, Ghossain A. et al. Peritoneal implants from ovarian tumors: CT findings. Radiology 1988; 169: 691-4.
• 10 Chatal JF, Saccavini JC, Fumoleau P. Immunoscintigraphy of gynecological carcinomas with ¹³¹I-OC-125-F(ab’)2 monoclonal antibody. J Nucl Med 1987; 28: 1807-19.
• 11 Davis HM, Zurawsky VR, Bast RC, Klug TL. Characterization of the CA 125 antigen associated with human epithelial ovarian carcinomas. Cancer Res 1986; 46: 6143-8.
• 12 Davis JO, Davis ER, Howe K. et al. Radionuclide imaging of ovarian tumours with ¹²³I-labelled monoclonal antibody (NDOG2) directed against placental alkaline phosphatase. Br J Obst Gynaecol 1985; 92: 277-86.
• 13 Deland FH, Goldenberg DM. Diagnosis and treatment of neoplasms with radionuclide-labeled antibodies. Sem Nucl Med 1985; 15: 2-11.
• 14 Dhokia B, Canney PA, Pectasides D. et al. A new immunoassay using monoclonal antibodies HMFG1 and HMFG2 together with an existing marker CA 125 for serological detection and management of epithelial ovarian cancer. Br J Cancer 1986; 54: 891-5.
• 15 Ebner F, Lahousen M, Steiner H, Kopp W. Abdominelle Computertomographie versus Second-Look-Operation bei chemotherapierten Ovarialkarzinomen. Tumor Diagn Ther 1986; 07: 145-9.
• 16 Epenetos AA, Carr D, Johnson PM, Boder WF, Lavender JP. Antibody-guided radiolocalisation of tumours in patients with testicular or ovarian cancer using two radioiodinated monoclonal antibodies to placental alkaline phosphatase. Br J Radiol 1986; 59: 117-25.
• 17 Giwerc M, Massulot J, George M, Rochard F, Haie C. Intérët de l’examen tomodensitometrique dans la surveillance des cancers de l’ovaire. J Radiol 1986; 67: 769-74.
• 18 Goldenberg DM, Kim EE, Deland FH, Bennet S, Primus FJ. Radioimmunodetection of cancer with radioactive antibodies to carcinoembryonic antigen. Cancer Res 1980; 40: 2984-91.
• 19 Goldhirsch A, Triller JK, Greiner R, Dreher E, Davis BW. Computed tomography prior to second look operation in advanced ovarian cancer. Obst Gynecol 1983; 62: 630-4.
• 20 Goldhirsch A, Joss R, Greiner R. Das Ovarialkarzinom: neue prognostische und therapeutische Gesichtspunkte. Schweiz Med Wschr 1981; 110: 1597-1601.
• 21 Granowska M, Nommon CC, Britton KE. Immunoscintigraphy of ovarian cancer by means of HMFG2 monoclonal antibody. In: Nuclear medicine in clinical oncology - Current status and future aspects. Winkler C. ed. Berlin: Springer; 1986: 171-76.
• 22 Griner PF, Mayewski RJ, Mushlin AS. Selection and interpretation of diagnostic tests and procedures. Ann Intern Med 1981; 94: 559-64.
• 23 Kivinen S, Kuoppala T, Leppilampi M, Vuori J, Kaupipila A. Tumor-associated antigen CA125 before and during the treatment of ovarian carcinoma. Obst Gynecol 1986; 67: 468-72.
• 24 Kohler G, Mielstein C. Continuous cultures of fused cells secreting antibodies of predefined specifity. Nature 1975; 256: 495-7.
• 25 Pansini F, Bellinazi A, Rainaldi V. et al. Serum CA 125 in ovarian pathology and its variation in ovarian carcinoma after integrated therapy. Gynecol Obst Invest 1986; 21: 47-51.
• 26 Pateisky N, Philipp K, Skolder WD. et al. Radioimmunodetection in patients with suspected ovarian cancer. J Nucl Med 1985; 26: 1369-75.
• 27 Pressman D, Keighley G. The zone of activity of antibodies as determined by the use of radioactive tracers; the zone of nephrotoxic anti-kidney serum. J Immunol 1948; 59: 141-9.
• 28 Rhode U, Steinbrich W, Friedmann G. Computertomographie der Ovarialtumoren - Fortschritte in der Diagnostik. Radiologe 1982; 22: 146-53.
• 29 van Nagel JR, Kim E, Casper S. et al. Radioimmunodetection of primary and metastatic ovarian cancer using radiolabeled antibodies to carcinoembryonic antigen. Cancer Res 1980; 40: 502-6.
• 30 Walsh JW, Rosenfield AT, Jaffe CC. et al. Prospective comparison of ultrasound and computed tomography in evaluation of gynecologic pelvic masses. Am J Roentgenol 1978; 131: 955-60.
• 31 Witebsky E. Desponsibilität und Spezifität alkohollöslicher Strukturen von Organen und bösartigen Geschwülsten. Z Immunitätsforsch Ext Ther 1929; 62: 35-73.
• 32 Del Vechio S, Reynolds JC, Carrasquillo JA, Lora ME, Larson SM. Human antimurin antibody (HAMA) concentration and HAMA-murine antibody (antibody-antibody) complexes. J Nucl Med 1987; 28: 614 (Abst).