Background: Squamous cell carcinoma of the head and neck frequently spreads to regional lymph nodes in early stages. While radioimmunoimaging has progressed to a rather routine diagnostic procedure in melanoma and colorectal carcinoma, nuclear medicine imaging in head and neck cancer previously was confined to nonspecific agents or cross-reacting monoclonal antibodies primarily raised against other tumor entities. However, the ideal radioimmunoagent is directed against tumor-associated epitopes of the cancer in question and is labeled with a radionuclide combining high image quality with low radiation burden to the patient. Patients and Methods: Five patients with primary pharyngeal carcinoma metastatic to ipsilateral and in two patients also to contralateral lymph nodes were investigated using a new technetium-99m-labeled monoclonal antibody (MoAb 174, TruScint SQTM) directed against cytoskeletal proteins of squamous cell carcinoma. All patients had their tumors surgically resected, and a final diagnosis was established. Patients also were monitored for toxicity, induction of anti-mouse antibodies (HAMA), and serum concentrations of different tumor markers. Results: No toxicity was observed. Primary tumors were correctly identified in 5/5, ipsilateral jugular lymph node metastases in 4/5, and deeper cervical metastases in 1/1 patients. Image interpretation was complicated because of nonspecific radioactivity in the nasal mucosa and in major vessels. False-positive results were found in contralateral jugular lymph nodes, the maxillary sinus mucosa and in one gleno-humeral joint. HAMA concentrations did not rise in any patient, while the concentrations of the tumor markers SCC and CYFRA-21-1 were not significantly different after surgery. Conclusions: In our opinion, radioimmunoimaging by means of technetium-99m-labeled anti-squamous carcinoma antibodies represents a major progress in functional diagnostic oncology. It aims at the evaluation of tumor metabolism, tissue vitality, and cellular antigenic patterns, in contrast to former less specific (and partly associated with a higher radiation burden) nuclear medicine imaging modalities, which are based on size criteria such as clinical examination, magnetic resonance imaging and other morphological investigations.

Keywords:
Radioimmunoimaging, Squamous cell carcinoma, Staging
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© 1993 S. Karger AG, Basel
1993
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