Unmasking the Primary: The Role of 99mTc-Sestamibi SPECT/CT in a Case of Carcinoma of Unknown Primary with Suspected Lung Origin
DOI:
https://doi.org/10.37275/bsm.v9i8.1361Keywords:
99mTc-sestamibi, Carcinoma of unknown primary, Lung cancer, Nuclear medicine, SPECT/CTAbstract
Background: Carcinoma of unknown primary (CUP) is a challenging clinical diagnosis, representing histologically confirmed metastatic cancer where the primary tumor site remains unidentified after a standard diagnostic workup. While 18F-FDG PET/CT is recommended by current guidelines, its accessibility is limited in many regions. This report explores the diagnostic utility of Technetium-99m (99mTc)-Sestamibi Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) as a valuable alternative.
Case presentation: A 67-year-old female presented with musculoskeletal pain. A biopsy of a right ulnar lesion confirmed metastatic carcinoma. Immunohistochemistry (IHC) suggested a possible primary from the lung, breast, or upper gastrointestinal tract. Due to the unavailability of 18F-FDG PET/CT, a 99mTc-Sestamibi whole-body scan with SPECT/CT was performed. The scan identified a metabolically active, malignant-appearing nodule in segment 6 of the left lung and confirmed widespread skeletal metastases. Although a lung biopsy was not feasible due to limited access, the patient was treated with a lung cancer protocol. This resulted in significant clinical improvement.
Conclusion: 99mTc-Sestamibi SPECT/CT served as a critical diagnostic tool in this case of CUP. It successfully identified a suspected pulmonary primary, enabling targeted therapy and leading to a positive clinical outcome. This case highlights the modality's efficacy as a tumor-seeking agent and underscores its essential role in the diagnostic armamentarium for CUP, particularly in resource-limited healthcare settings.
Authors
- Jessica Ubercaprita1*
- Endah Indriani Wahyono1
- Mas Adi Sunardi2
- Herry Herman3
- Bethy Suryawathy Hernowo4
- Basuki Hidayat1
- 1Department of Nuclear Medicine and Molecular Theranostics, School of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
- 2Department of Radiation Oncology, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
- 3Department of Orthopaedic Surgery, Dr. Hasan Sadikin General Hospital/School of Medicine Universitas Padjadjaran, Bandung, Indonesia
- 4Department of Anatomical Pathology, Dr. Hasan Sadikin General Hospital/School of Medicine Universitas Padjadjaran, Bandung, Indonesia
Corresponding author Jessica Ubercaprita — jessubercaprita@gmail.com
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