Intraoperative gamma probe detection of pancreatic neuroendocrine tumours using preoperative indium octreotide injection

  • Mr Mark Dobson, Department of Nuclear Medicine & Ultrasound, Bankstown Lidcombe Hospital, Sydney, NSW, Australia., Australia
  • Dr Jeremy Hoang, Department of Nuclear Medicine & Ultrasound, Bankstown Lidcombe Hospital, Sydney, NSW, Australia., Australia
  • Dr Quee Li Chiam, Department of Nuclear Medicine & Ultrasound, Bankstown Lidcombe Hospital, Sydney, NSW, Australia., Australia
  • Dr Neil Merrett, Department of Surgery, Bankstown Lidcombe Hospital, Sydney, NSW, Australia., Australia
  • Dr Andrew Biankin, Department of Surgery, Bankstown Lidcombe Hospital, Sydney, NSW, Australia., Australia
  • Dr Hugh Dixson, Department of Nuclear Medicine & Ultrasound, Bankstown Lidcombe Hospital, Sydney, NSW, Australia., Australia
  • Dr Kien Lee, Department of Nuclear Medicine & Ultrasound, Bankstown Lidcombe Hospital, Sydney, NSW, Australia., Australia

    • Background: A 74 year old male presented with a mass in the tail of the pancreas. Endoscopic ultrasound and fine needle biopsy demonstrated a 4 cm cystic pancreatic neuroendocrine tumour.

    Method: An indium octreotide scan (111-In octreotide) with SPECT/CT was performed and demonstrated an intensively avid lesion in the tail of the pancreas and less avid focus in the region of the uncinate process. One day prior to the operation a second injection of 100MBq of 111-In octreotide was administrated for intraoperative localisation using a gamma probe during resection of the endocrine tumours.

    Results: Intraoperative gamma probe successfully identified a 4cm tumour lesion in the tail of the pancreas and a 1cm lesion in the uncinate process of the pancreas. Both lesions were resected and subsequently imaged. Gamma camera images demonstrated markedly increased octreotide uptake in both resected tumour lesions compared to normal pancreatic tissue.

    Conclusion: Preoperative injection of 111-In octreotide with the use of an intraoperative gamma probe allows for the intraoperative of detection of the pancreatic neuroendocrine tumours. The gamma probe successfully identifies octreotide avid tumours despite the high background activity of nearby normal octreotide avid tissue such as liver and spleen. This technique provides for the final surgical localisation and the complete resection of octreotide avid tumours, and demonstrates how nuclear medicine can be an integral part of successful surgery of pancreatic neuroendocrine tumours.