False tumor-positive lymph nodes in radioimmunodiagnosis and radioimmunoguided surgery: etiologic mechanisms.

We investigated the causes of false-positive (nontumor cell) focal uptake in radioimmunodiagnosis (RAID) and false-positive high counts in radioimmunoguided surgery (RIGS). Tissue blocks of two such RAID cases were recut and examined by immunohistochemistry (IH) (group 1). Lymph nodes in the drainage area of 14 colon cancers selected because of tumor-positive draining nodes were examined similarly (group 2). The lymph nodes in group 1 showed nontumor cell germinal center (GC) and rare macrophage (M phi) positivity with monoclonal antibody (mAb) CC49 to tumor antigen (Ag) TAG-72, the same Ag to which the mAb B72.3, used for the RAID studies, was directed. In group 2, CC49 staining was observed in the colon cancers, in noncellular tumor Ag in lymphatic channels, and in the GC of draining nodes in a pattern similar to that of follicular dendritic cells (FDC). An In-111-mAb/tumor Ag (TAG-72 or CEA) complex can result in false-positive RAID/RIGS studies by In-111 retained in the lysosomes of lymph node M phi, following attachment of the mAb to the Ag, and their catabolism in the M phi. An I-125-mAb to either tumor Ag could lead to false positive RIGS studies due to its attachment to the Ag portion of ag/ab complexes affixed to the FDC in the GC of the lymph nodes draining a tumor.