Open Access Research

The role of thallium-201 and pentavalent dimercaptosuccinic acid for staging cartilaginous tumours

Peter FM Choong15*, Toshiyuki Kunisada1, John Slavin3, Stephen Schlicht2 and Rodney Hicks4

Author Affiliations

1 Department of Orthopaedics, University of Melbourne, St. Vincent's Hospital, Melbourne, Australia

2 Department of Medical Imaging, St. Vincent's Hospital, Melbourne, Australia

3 Department of Pathology, St. Vincent's Hospital, Melbourne, Australia

4 Department of Medical Imaging, Peter MacCallum Cancer Institute, Melbourne, Australia

5 Division of Surgical Oncology, Peter MacCallum Cancer Institute, Melbourne, Australia

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International Seminars in Surgical Oncology 2004, 1:10  doi:10.1186/1477-7800-1-10

Published: 8 November 2004

Abstract

Introduction

Heterogeneity of cartilage tumours may confound accurate diagnosis and grading resulting in under and over treatment. Improved preoperative assessment of malignancy and grade would be invaluable for developing a rational plan for treatment. We examined correlations between nuclear tracer avidity and malignancy grade in cartilage tumours.

Methods

Between 1996 and 2000, 92 consecutive patients with cartilaginous tumours (50 benign, 42 non-metastatic malignant) underwent nuclear scanning. Thallium-201 (TL-201) and pentavalent dimercaptosuccinic acid (DMSAV) were used as nuclear isotopes. Scanning with these agents was performed on separate days 48 hours apart. Static and SPECT images were obtained at 30 m and 4 h after injection of nuclear tracer. Pathology review was undertaken blinded to the results of the nuclear scans and correlations between histologic results and trace uptake at 4 hours examined.

Results

25 patients with negative DMSAV had benign tumours. 15/17 tumours with positive TL-201 had malignant tumours. 11/13 patients with both positive DMSAV and TL-201 scans had intermediate or high grade tumours and 4 of these developed metastases. We have developed an algorithm for the management of patients with tumours that aims to avoid over treatment of low grade tumours and under treatment of high grade tumours.

Conclusion

Functional nuclear scanning with TL-201 and DMSAV complements other imaging modalities in the management of cartilaginous tumours.