Targeted Dual-Modality Imaging in Renal Cell Carcinoma: An Ex Vivo Kidney Perfusion Study

Clin Cancer Res. 2016 Sep 15;22(18):4634-42. doi: 10.1158/1078-0432.CCR-15-2937. Epub 2016 Apr 21.


Purpose: Antibodies labeled with both a near-infrared fluorescent dye and a radionuclide can be used for tumor-targeted intraoperative dual-modality imaging. Girentuximab is a chimeric monoclonal antibody against carbonic anhydrase IX (CAIX), an antigen expressed in 95% of clear cell renal cell carcinoma (ccRCC). This study aimed to assess the feasibility of targeted dual-modality imaging with (111)In-girentuximab-IRDye800CW using ex vivo perfusion of human tumorous kidneys.

Experimental design: Seven radical nephrectomy specimens from patients with ccRCC were perfused during 11 to 15 hours with dual-labeled girentuximab and subsequently rinsed during 2.5 to 4 hours with Ringer's Lactate solution. Then, dual-modality imaging was performed on a 5- to 10-mm-thick lamella of the kidney. Fluorescence imaging was performed with a clinical fluorescence camera set-up as applied during image-guided surgery. The distribution of Indium-111 in the slice of tumor tissue was visualized by autoradiography. In two perfusions, an additional dual-labeled control antibody was added to demonstrate specific accumulation of dual-labeled girentuximab in CAIX-expressing tumor tissue.

Results: Both radionuclide and fluorescence imaging clearly visualized uptake in tumor tissue and tumor-to-normal tissue borders, as confirmed (immuno)histochemically and by gamma counting. Maximum uptake of girentuximab in tumor tissue was 0.33% of the injected dose per gram (mean, 0.12 %ID/g; range, 0.01-0.33 %ID/g), whereas maximum uptake in the normal kidney tissue was 0.04 %ID/g (mean, 0.02 %ID/g; range, 0.00-0.04 %ID/g).

Conclusions: Dual-labeled girentuximab accumulated specifically in ccRCC tissue, indicating the feasibility of dual-modality imaging to detect ccRCC. A clinical study to evaluate intraoperative dual-modality imaging in patients with ccRCC has been initiated. Clin Cancer Res; 22(18); 4634-42. ©2016 AACR.

MeSH terms

  • Antibodies, Monoclonal
  • Benzenesulfonates
  • Carcinoma, Renal Cell / diagnostic imaging*
  • Carcinoma, Renal Cell / pathology*
  • Carcinoma, Renal Cell / surgery
  • Diagnostic Imaging / methods*
  • Humans
  • In Vitro Techniques
  • Indoles
  • Iodine Radioisotopes
  • Kidney Neoplasms / diagnostic imaging*
  • Kidney Neoplasms / pathology*
  • Kidney Neoplasms / surgery
  • Microscopy, Fluorescence
  • Neoplasm Staging
  • Nephrectomy
  • Perfusion Imaging / methods
  • Tumor Burden


  • Antibodies, Monoclonal
  • Benzenesulfonates
  • G250 monoclonal antibody
  • IRDye 800CW
  • Indoles
  • Iodine Radioisotopes