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Identification of occult metastases of medullary thyroid carcinoma by pentagastrin-stimulated intravenous calcitonin sampling followed by targeted surgery
- Source :
- Clinical Endocrinology
- Publication Year :
- 2007
- Publisher :
- Wiley, 2007.
-
Abstract
- Summary Background High calcitonin (CT) serum levels suggest metastatic spread in medullary thyroid carcinoma (MTC) after thyroidectomy. In limited disease stages, however, morphological investigations including ultrasound, magnetic resonance imaging (MRI) and 18FFDG positron emission tomography ([18F]FDG-PET) may often fail to identify exact tumour sites. Objective The aim of the present study was to establish an improved strategy to identify small cervical tumours by combining pentagastrin stimulation with bilateral cervical intravenous CT sampling followed by high-resolution ultrasound. Design and patients Six MTC patients were examined, of whom five patients already had bilateral neck dissection. Five patients had sporadic MTC, and one patient suffered from MEN2a. Results Retrospective analysis of all patients revealed a highly sensitive positive correlation between an early calcitonin peak (20 ‐ 40 s after pentagastrin injection) and site of cervical tumour affection. Postinterventional ultrasound examination of the affected regions of the neck revealed suspicious presence; in some cases small lymph nodes of less than 1 cm in size were then surgically excised. On histology, small tumours could be identified in four patients. Postsurgical examination revealed a clear decline of basal serum calcitonin levels in four patients (between − 41% and − 100%). In two patients CT normalized to baseline levels (< 10 pg /ml) and in another two patients CT rendered to near normal (14 and 17 pg/ml). Conclusion Pentagastrin stimulation-based intravenous catheter sampling may be beneficial in the diagnostic work-up of MTC after thyroidectomy. Our data show that an early calcitonin peak (20 ‐ 40 s after administration of pentagastrin) helps to identify tumour-affected regions.
- Subjects :
- Adult
Calcitonin
Male
medicine.medical_specialty
Luminescence
Neoplasm, Residual
Endocrinology, Diabetes and Metabolism
medicine.medical_treatment
Multiple Endocrine Neoplasia Type 2a
Thyroid carcinoma
Endocrinology
Internal medicine
Biomarkers, Tumor
medicine
Humans
Thyroid Neoplasms
Thyroid cancer
Retrospective Studies
medicine.diagnostic_test
business.industry
Thyroidectomy
Magnetic resonance imaging
Neck dissection
Middle Aged
medicine.disease
Surgery
Pentagastrin
Medullary carcinoma
Carcinoma, Medullary
Lymphatic Metastasis
Original Article
Female
business
medicine.drug
Subjects
Details
- ISSN :
- 13652265 and 03000664
- Volume :
- 66
- Database :
- OpenAIRE
- Journal :
- Clinical Endocrinology
- Accession number :
- edsair.doi.dedup.....3a46b23a217a88fc942470ee8947cf5b