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Original Article

The role of technetium Tc99m-tetrofosmin as head and neck
tumor-seeking agent: a preliminary report

Chrissa Sioka , Thomas Exarchopoulos , Vlasis Skloupiotis , Vaios Papathanassiou , Vasileios Ragos ,
3
2
1
1
4
Maria Argyropoulou , Anna Gousia , Periklis Tsekeris , Georgios Exarchakos , Dimitrios Assimakopoulos ,
3
5
6
2
3
Andreas Fotopoulos 1
1 Department of Nuclear Medicine, University of Ioannina School of Medicine, University Campus, Ioannina 45110, Greece.
2 Department of Radiotherapy, University of Ioannina School of Medicine, University Campus, Ioannina 45110, Greece.
3 Department of Ear Nose and Throat, University of Ioannina School of Medicine, University Campus, Ioannina 45110, Greece.
4 Department of Maxillofacial Surgery, University of Ioannina School of Medicine, University Campus, Ioannina 45110, Greece.
5 Department of Radiology, University of Ioannina School of Medicine, University Campus, Ioannina 45110, Greece.
6 Department of Pathology, University of Ioannina School of Medicine, University Campus, Ioannina 45110, Greece.
Correspondence to: Dr. Chrissa Sioka, Department of Nuclear Medicine, University of Ioannina School of Medicine, University Campus, Ioannina 45110,
Greece. E-mail: csioka@yahoo.com
A B S T R AC T
Aim: To evaluate the diagnostic value of technetium Tc99m-tetrofosmin ( 99m Tc-TF) in primary cancers of the head and neck.
Methods: Single photon emission computer tomography with planar imaging of the neck for primary site evaluation and whole
body scanning for assessment of metastases in 12 patients with newly diagnosed head and neck cancer. Tumor-to-background
index (T/Bg) was derived in patients with positive findings (tumor or lymph nodes). Results: The tomographic images showed
increased tracer uptake in pathological sites (primary tumor or lymph node) in 9 patients (overall sensitivity 75%). Primary tumor
was visualised in 7 patients (sensitivity 58%) and infiltrated lymph nodes in 4 out 7 patients (sensitivity 57%). Mean values for
T/Bg index were 5.44 ± 1.28 for primary tumor and 4.25 ± 1.67 for lymph nodes. Mean values for T/Bg index were 4.5 ± 0.71 for
patients with in situ and grade I carcinoma and 6.68 ± 0.36 for patients with tumor grade II and III (P = 0.034, Mann-Whitney U
test). Conclusion: The present study demonstrates that 99m Tc-TF is a valuable radiotracer for head and neck cancer imaging. To
determine the potential role of this imaging protocol in clinical practice will require a larger sample size.

Key words: Head and neck cancer; radionuclide imaging; single photon emission computer tomography; Technetium-tetrofosmin
99m

INTRODUCTION due to extensive distortion of the normal anatomy, and may
require a combination of different imaging tests, [3-7] such
Malignant tumors of the head and neck are among the as PET scan. [8-11] However, its availability is limited by the
six most common forms of tumors in the body. Head and need for a cyclotron that produces Fluorodeoxyglucose
18
neck cancer include neoplasms of the upper respiratory ( FDG) and its increased cost. In addition, in many
18
tract (nasopharynx, oropharynx, larynx) salivary glands, countries, PET is not widely available so other methods are
and soft tissue of the neck with squamous cell carcinoma needed for tumor-imaging assessment.
being the most frequent histological type. Diagnosis of
this type of cancer is based on endoscopy and biopsy of When a PET scanner is not available, nuclear medicine still
the suspicious lesion. Staging and evaluation of the extent plays a crucial role in the initial staging of the disease and
[1]
of disease involves the use of computed tomography (CT), for follow ups. Lymph node cancerous involvement at initial
magnetic resonance imaging (MRI) and positron emission presentation may be difficult to assess by conventional
tomography (PET). Follow-up evaluations after surgery
[2]
and/or radiotherapy and differential diagnosis of disease This is an open access article distributed under the terms of the Creative
Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows
relapse from radiation necrosis is more difficult to assess, others to remix, tweak, and build upon the work non-commercially, as long as
the author is credited and the new creations are licensed under the identical
terms.
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http://jcmtjournal.com How to cite this article: Sioka C, Exarchopoulos T, Skloupiotis V,
Papathanassiou V, Ragos V, Argyropoulou M, Gousia A, Tsekeris
P, Exarchakos G, Assimakopoulos D, Fotopoulos A. The role of
technetium Tc99m-tetrofosmin as head and neck tumor-seeking agent:
DOI: a preliminary report. J Cancer Metastasis Treat 2016;2:133-8.
10.20517/2394-4722.2015.65
Received: 24-08-2015; Accepted: 19-12-2015.

©2016 Journal of Cancer Metastasis and Treatment ¦ Published by OAE Publishing Inc. 133