Immunoscintigraphy of adenocarcinomas by means of¹¹¹In-labelled F(Ab')₂fragments of anti-CEA monoclonal antibody F023C5

F(ab')₂fragments of F023C5, an anti-CEA monoclonal antibody, were conjugated to diethylenet- riamine pentaacetic add (DTPA) and converted into a ready to use reagent for instant¹¹¹In-labelling. The resulting nlIn radiopharmaceutical (2-3 mCi/0.5 mg of F(ab')₂fragments) was administered intravenously and tested for its ability to image (at 48-72 h after administration) 31 primary and 85 metastatic carcinoma lesions in 70 adenocarcinoma patients (26 gastrointestinal, 18 breast and 26 lung tumour patients) whose serum CEA was elevated in 43 cases and normal in the other 27. The results were as follows: no adverse reactions or evidence of toxicity were observed in any of the patients. positive immunoscintigraphy results were obtained in 78% CEA-seropositive and in 64% seronegative patients. the fraction of documented lesions which was imaged was 69% in CEA-seropositive patients and 39% in seronegative patients. several 'unexpected' radiolocalizations were imaged; 30/34 were confirmed as (previously occult) tumour lesions in follow-up studies. In 6 patients, the immunoscintigraphic demonstration of previously occult lesions contributed to the early detection of tumour recurrences. the major limitation of the method is the non-specific radioactivity accumulation in the liver, which prevents the detection of liver metastases. in CEA-seropositive patients the fraction of imaged extra-hepatic tumour lesions is over 80%. the major cause of negative immunoscintigraphy results is lack of CEA in the tumour lesion, as demonstrated by immunohistochemistry of surgically removed tumours.