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Indium-111-Octreotide a Potential Diagnostic Tool for Differentiated Thyroid Cancer

Indium-111-Octreotide is a sensitive diagnostic tool for detecting multiple metastases in patients with advanced thyroid cancer who do not respond to iodine-131.

Differentiated thyroid cancer is most often treated with surgery followed by ablation with iodine-131 (I-131). Whole body scintigraphy (WBS) with I-131 is often used to detect tumour recurrence and metastasis. Unfortunately, I-131 is not effectively concentrated in some patients with more aggressive metastases, thus emphasising the need for alternative diagnostic tools.

Indium-111 Octreotide (Octreoscan) is a radio-labelled somatostatin analogue that binds to somatostatin receptors that are highly expressed in medullary and in papillary thyroid cancer. It may therefore be useful for the visualisation of metastases in medullary and differentiated thyroid cancer.

Marcel P. M. Stokkel and colleagues at the Leiden University Medical Centre, the Netherlands, evaluated the use of Indium-111 Octreotide in differentiated thyroid cancer patients who failed to respond to treatment with high-dose I-131.

The study included 15 patients (10 female and 5 male, ages 13 to 81 years) with progressive thyroid cancer that showed increasing levels of plasma thyroglobulin (Tg) even after treatment with high dose I-131. WBS was performed 4 hours and 24 hours after treatment with 200 MBq of Indium-111-Octreotide.

The majority of patients had advanced disease. Distant metastases were present in 7 patients and T3 or T4 tumours in 10 patients.

Overall, Indium-111-Octreotide showed a positive result in 12 patients, indicating a sensitivity of 80%.

Indium-111-Octreotide gave a false negative result in 2 out of 5 patients with a positive I-131 WBS. Conversely, Indium-111-Octreotide identified multiple metastases in 9 out of 10 patients that had a negative I-131 WBS.

Indium-111-Octreotide detected metastases in the lungs (n=14), bone (n=7), mediastinum (n=3), liver (n=2), brains (n=1), and cutis (n=1).

A slight to moderate increased uptake of Indium-111-Octreotide was observed in 10 patients. The authors note that this observation suggests "the possibility for additional treatment with high doses of Indium-111-Octreotide or its analogues in a majority of the patients."

The authors further conclude that these results support "the diagnostic value of Indium-111-Octreotide in differentiated thyroid cancer."
J Cancer Res Clin Oncol 2003 May;129(5):287-94. Epub 2003 May 15. "Indium-111-Octreotide scintigraphy in differentiated thyroid carcinoma metastases that do not respond to treatment with high-dose I-131"

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