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D. J. Torpy, C. C. Chen, N. Mullen, J. L. Doppman, J. A. Carrasquillo, G. P. Chrousos, L. K. Nieman, Primary Localization of an Ectopic ACTH-Producing Bronchial Carcinoid Tumor by Indium 111Pentetreotide Scintigraphy—Authors’ Response, The Journal of Clinical Endocrinology & Metabolism, Volume 84, Issue 9, 1 September 1999, Pages 3402–3406, https://doi.org/10.1210/jcem.84.9.6011-4
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Dr. M. Reincke’s letter (above) illustrates an important principle in the development of diagnostic tests—results from additional patients should be reported to evaluate the validity of the conclusions from earlier studies. In the case (1) and Dr. Tabarin’s group (2), reported on 30 patients undergoing 111Indium pentetreotide scintigraphy as well as conventional computed tomography (CT) and magnetic resonance (MR) examination to localize an ectopic ACTH-producing tumor. Both studies demonstrated that conventional imaging had superior sensitivity and fewer false positive results compared to scintigraphy. Furthermore, only one patient’s tumor was detected by scintigraphy alone (although subsequent CT confirmed the mass). In our study 7 of 17 positive scintigrams were falsely positive; of these, 4 were associated with nonendocrine lesions, such as fibrosis, on MR or CT scans. However, 3 required additional diagnostic tests and included a lesion that was not present on subsequent scintigraphy. Scintigraphy was the first correct indication of a tumor in 1 patient in Dr. Tabarin’s study and was falsely positive in 1 patient. Both articles concluded that conventional imaging should be the first line approach to detection of these tumors and that scintigraphy is an adjunctive modality.
