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

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 preoperative and intra-operative procedures remain not entirely satisfactory. The use of intra-operative ¹¹¹In-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 ¹¹¹In-pentetreotide scan, radio-guided surgery was performed using a hand-held gamma probe 24 h after i.v. administration of the tracer. Results: The ¹¹¹In-pentetreotide radioguided surgery with hand-held gamma probe, if compared with pre-operative ¹¹¹In-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 ¹¹¹In-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 ¹¹¹In- pentetreotide scan as a promising procedure in the management of ACTH-secreting bronchial carcinoids.