1
|
EANM practice guideline for PET/CT imaging in medullary thyroid carcinoma. Eur J Nucl Med Mol Imaging 2019; 47:61-77. [DOI: 10.1007/s00259-019-04458-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 07/22/2019] [Indexed: 01/30/2023]
|
2
|
Beukhof CM, Brabander T, van Nederveen FH, van Velthuysen MLF, de Rijke YB, Hofland LJ, Franssen GJH, Fröberg LAC, Kam BLR, Visser WE, de Herder WW, Peeters RP. Peptide receptor radionuclide therapy in patients with medullary thyroid carcinoma: predictors and pitfalls. BMC Cancer 2019; 19:325. [PMID: 30953466 PMCID: PMC6451300 DOI: 10.1186/s12885-019-5540-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/28/2019] [Indexed: 12/29/2022] Open
Abstract
Background For progressive metastatic medullary thyroid carcinoma (MTC), the available treatment options with tyrosine kinase inhibitors result in grade 3–4 adverse events in a large number of patients. Peptide Receptor Radionuclide Therapy (PRRT), which has also been suggested to be a useful treatment for MTC, is usually well tolerated, but evidence on its effectivity is very limited. Methods Retrospective evaluation of treatment effects of PRRT in a highly selected group of MTC patients, with progressive disease or refractory symptoms. In addition, a retrospective evaluation of uptake on historical 111In-DTPA-octreotide scans was performed in patients with detectable tumor size > 1 cm. Results Over the last 17 years, 10 MTC patients were treated with PRRT. Four out of 10 patients showed stable disease at first follow-up (8 months after start of therapy) whereas the other 6 were progressive. Patients with stable disease were characterized by a combination of both a high uptake on 111In-DTPA-octreotide scan (uptake grade ≥ 3) and a positive somatostatin receptor type 2a (SSTR2a) expression of the tumor by immunohistochemistry. Retrospective evaluation of historical 111In-DTPA-octreotide scans of 35 non-treated MTC patients revealed low uptake (uptake grade 1) in the vast majority of patients 31/35 (89%) with intermediate uptake (uptake grade 2) in the remaining 4/35 (11%). Conclusions PRRT using 177Lu-octreotate could be considered as a treatment in those patients with high uptake on 111In-DTPA-octreotide scan (uptake grade 3) and positive SSTR2a expression in tumor histology. Since this high uptake was present in a very limited number of patients, this treatment is only suitable in a selected group of MTC patients.
Collapse
Affiliation(s)
- Carolien M Beukhof
- Erasmus MC, Department of Internal Medicine, Academic Center for Thyroid Diseases, European Neuroendocrine Tumor Society center of excellence, P.O Box 2040, 3000, CA, Rotterdam, the Netherlands.
| | - Tessa Brabander
- Erasmus MC, Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, P.O Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Francien H van Nederveen
- Erasmus MC, Department of Pathology, Erasmus University Medical Center, P.O Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Marie-Louise F van Velthuysen
- Erasmus MC, Department of Pathology, Erasmus University Medical Center, P.O Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Yolanda B de Rijke
- Erasmus MC, Department of Internal Medicine, Academic Center for Thyroid Diseases, European Neuroendocrine Tumor Society center of excellence, P.O Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Leo J Hofland
- Erasmus MC, Department of Internal Medicine, Academic Center for Thyroid Diseases, European Neuroendocrine Tumor Society center of excellence, P.O Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Gaston J H Franssen
- Erasmus MC, Department of Internal Medicine, Academic Center for Thyroid Diseases, European Neuroendocrine Tumor Society center of excellence, P.O Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Lideke A C Fröberg
- Erasmus MC, Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, P.O Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Boen L R Kam
- Erasmus MC, Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, P.O Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - W Edward Visser
- Erasmus MC, Department of Internal Medicine, Academic Center for Thyroid Diseases, European Neuroendocrine Tumor Society center of excellence, P.O Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Wouter W de Herder
- Erasmus MC, Department of Internal Medicine, Academic Center for Thyroid Diseases, European Neuroendocrine Tumor Society center of excellence, P.O Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Robin P Peeters
- Erasmus MC, Department of Internal Medicine, Academic Center for Thyroid Diseases, European Neuroendocrine Tumor Society center of excellence, P.O Box 2040, 3000, CA, Rotterdam, the Netherlands
| |
Collapse
|
3
|
Yamaga LYI, Cunha ML, Campos Neto GC, Garcia MRT, Yang JH, Camacho CP, Wagner J, Funari MBG. 68Ga-DOTATATE PET/CT in recurrent medullary thyroid carcinoma: a lesion-by-lesion comparison with 111In-octreotide SPECT/CT and conventional imaging. Eur J Nucl Med Mol Imaging 2017; 44:1695-1701. [PMID: 28429044 DOI: 10.1007/s00259-017-3701-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/03/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to prospectively compare the detection rate of 68Ga-DOTATATE PET-CT with 111In-octreotide SPECT-CT and conventional imaging (CI) in medullary thyroid carcinoma (MTC) patients with increased calcitonin (Ctn) levels but negative CI after thyroidectomy. METHODS Fifteen patients with raised Ctn levels and/or CI evidence of recurrence underwent 68Ga-DOTATATE PET-CT, 111In-octreotide SPECT-CT and CI. Histopathology, CI and biochemical/clinical/imaging follow-up were used as the reference standard. PET/CT, SPECT/CT and CI were compared in a lesion-based and organ-based analysis. RESULTS PET/CT evidenced recurrence in 14 of 15 patients. There were 13 true positive (TP), 1 true negative (TN), 1 false positive (FP) and no false negative (FN) cases, resulting in a sensitivity and accuracy of 100% and 93%. SPECT/CT was positive in 6 of 15 cases. There were 6 TP, 2 TN, 7 FN and no FP cases, resulting in a sensitivity of 46% and accuracy of 53%. CI procedures detected tumor lesions in 14 of 15 patients. There were 13 TP, 1TN, 1 FP and no FN cases with a sensitivity of 100% and accuracy of 93%. A significantly higher number of lesions was detected by PET/CT (112 lesions, p = 0.005) and CI (109 lesions, p = 0.005) in comparison to SPECT/CT (16 lesions). There was no significant difference between PET/CT and CI for the total number of detected lesions (p = 0.734). PET/CT detected more lesions than SPECT/CT regardless of the organ. PET/CT detected more bone lesions but missed some neck nodal metastases evidenced by CI. The number of lesions per region demonstrated by PET/CT and CI were similar in the other sites. CONCLUSION 68Ga-DOTATATE PET/CT is superior to 111In-octreotide SPECT/CT for the detection of recurrent MTC demonstrating a significantly higher number of lesions. 68Ga-DOTATATE PET/CT showed a superior detection rate compared to CI in demonstrating bone metastases.
Collapse
Affiliation(s)
- Lilian Yuri Itaya Yamaga
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05651-901, Brazil. .,, Rua Jose Maximo Monteiro de Oliveira, 196, Parque dos Príncipes, Osasco, São Paulo, CEP 06030-362, Brazil.
| | - Marcelo L Cunha
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05651-901, Brazil
| | - Guilherme C Campos Neto
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05651-901, Brazil
| | - Marcio R T Garcia
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05651-901, Brazil
| | - Ji H Yang
- Multiple Neoplasia Outpatiet Clinic, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Cleber P Camacho
- Multiple Neoplasia Outpatiet Clinic, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jairo Wagner
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05651-901, Brazil
| | - Marcelo B G Funari
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05651-901, Brazil
| |
Collapse
|
4
|
Raue F, Frank-Raue K. Epidemiology and Clinical Presentation of Medullary Thyroid Carcinoma. Recent Results Cancer Res 2016; 204:61-90. [PMID: 26494384 DOI: 10.1007/978-3-319-22542-5_3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor originating from the thyroid C cells producing mainly calcitonin (CTN) used as tumor marker. MTC occurs either sporadic (75%) or in a hereditary form (multiple endocrine neoplasia type 2, MEN2), due to germline mutations in the RET proto-oncogene. The discovery of an MTC in a patient has several diagnostic implications involving a specific strategy: preoperative evaluation of the tumor marker CTN and the extent of the disease, classification of MTC as sporadic or hereditary by DNA testing, and screening for associated endocrinopathies in hereditary MTC. Elevated CTN is a highly sensitive and specific tumor marker for diagnosis and follow-up of MTC. CTN is directly related to the tumor mass. In patients with nodular thyroid disease, diagnosis of MTC could be made by CTN determination as an indicator of tumor burden in conjunction with fine-needle aspiration. Patients with confirmed sporadic or hereditary MTC should have a total thyroidectomy and depending on the preoperative CTN value and the extent of disease additional dissection of the lymph nodes in the central and lateral neck compartment. In MEN 2 patients diagnosed by screening, the time of prophylactic thyroidectomy depends on RET mutation and CTN level.
Collapse
Affiliation(s)
- Friedhelm Raue
- Endokrinologische Gemeinschaftspraxis, Brückenstr. 21, 69120, Heidelberg, Germany.
| | - Karin Frank-Raue
- Endokrinologische Gemeinschaftspraxis, Brückenstr. 21, 69120, Heidelberg, Germany
| |
Collapse
|
5
|
The current place and indications of 131I-metaiodobenzylguanidine therapy in the era of peptide receptor radionuclide therapy: determinants to consider for evolving the best practice and envisioning a personalized approach. Nucl Med Commun 2015; 36:1-7. [PMID: 25299467 DOI: 10.1097/mnm.0000000000000209] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
6
|
Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, Lee N, Machens A, Moley JF, Pacini F, Raue F, Frank-Raue K, Robinson B, Rosenthal MS, Santoro M, Schlumberger M, Shah M, Waguespack SG. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid 2015; 25:567-610. [PMID: 25810047 PMCID: PMC4490627 DOI: 10.1089/thy.2014.0335] [Citation(s) in RCA: 1236] [Impact Index Per Article: 137.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The American Thyroid Association appointed a Task Force of experts to revise the original Medullary Thyroid Carcinoma: Management Guidelines of the American Thyroid Association. METHODS The Task Force identified relevant articles using a systematic PubMed search, supplemented with additional published materials, and then created evidence-based recommendations, which were set in categories using criteria adapted from the United States Preventive Services Task Force Agency for Healthcare Research and Quality. The original guidelines provided abundant source material and an excellent organizational structure that served as the basis for the current revised document. RESULTS The revised guidelines are focused primarily on the diagnosis and treatment of patients with sporadic medullary thyroid carcinoma (MTC) and hereditary MTC. CONCLUSIONS The Task Force developed 67 evidence-based recommendations to assist clinicians in the care of patients with MTC. The Task Force considers the recommendations to represent current, rational, and optimal medical practice.
Collapse
Affiliation(s)
- Samuel A. Wells
- Genetics Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sylvia L. Asa
- Department of Pathology, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Henning Dralle
- Department of General, Visceral, and Vascular Surgery, University Hospital, University of Halle-Wittenberg, Halle/Saale, Germany
| | - Rossella Elisei
- Department of Endocrinology, University of Pisa, Pisa, Italy
| | - Douglas B. Evans
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert F. Gagel
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Andreas Machens
- Department of General, Visceral, and Vascular Surgery, University Hospital, University of Halle-Wittenberg, Halle/Saale, Germany
| | - Jeffrey F. Moley
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Furio Pacini
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Friedhelm Raue
- Endocrine Practice, Moleculargenetic Laboratory, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Karin Frank-Raue
- Endocrine Practice, Moleculargenetic Laboratory, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Bruce Robinson
- University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - M. Sara Rosenthal
- Departments of Internal Medicine, Pediatrics and Behavioral Science, University of Kentucky, Lexington, Kentucky
| | - Massimo Santoro
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Universita' di Napoli “Federico II,” Napoli, Italy
| | - Martin Schlumberger
- Institut Gustave Roussy, Service de Medecine Nucleaire, Université of Paris-Sud, Villejuif, France
| | - Manisha Shah
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Steven G. Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
7
|
Abstract
Imaging plays an important role in early detection and staging of medullary thyroid carcinoma (MTC) as well as in follow-up to localize early recurrence. MTC is a rare, calcitonin-secreting thyroid malignancy often diagnosed by ultrasound and calcitonin screening as part of the routine workup for any thyroid nodule. If calcitonin is elevated, imaging studies are needed for preoperative staging, which dictates surgical management. This can be done by ultrasound of the neck and abdomen. Computed tomography (CT) or magnetic resonance imaging (MRI) studies for more distant disease are done preoperatively if calcitonin levels are higher than 500 pg/ml. Neither FDG-PET/CT nor F-DOPA-PET/CT are used routinely for preoperative staging but may contribute in doubtful individual cases. Postoperative elevated calcitonin is related to persistence or recurrence of MTC. Imaging studies to localize tumor tissue during postoperative follow-up include ultrasound, CT, MRI as well as PET studies. They should be used wisely, however, since treatment consequences are often limited, and even patients with persistent disease may survive long enough to accumulate significant radiation doses. Imaging studies are also useful for diagnosis of associated components of the hereditary MTC such as pheochromocytoma and primary hyperparathyroidism (pHPT).
Collapse
|
8
|
Abstract
Medullary thyroid carcinoma (MTC) is a rare type of thyroid cancer, demonstrating variable behavior from indolent disease to highly aggressive, progressive disease. There are distinguishing phenotypic features of sporadic and hereditary MTC. Activation or overexpression of cell surface receptors and up-regulation of intracellular signaling pathways in hereditary and sporadic MTC are involved in the disease pathogenesis. There has been an exponential rise in clinical trials with investigational agents, leading to approval of 2 medications for progressive, advanced MTC. Developments in understanding the pathogenesis of MTC will hopefully lead to more effective and less toxic treatments of this rare but difficult to treat cancer.
Collapse
Affiliation(s)
- Mimi I Hu
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1461, Houston, TX 77030, USA
| | - Anita K Ying
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1461, Houston, TX 77030, USA
| | - Camilo Jimenez
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1461, Houston, TX 77030, USA.
| |
Collapse
|
9
|
Lodish M, Dagalakis U, Chen CC, Sinaii N, Whitcomb P, Aikin A, Dombi E, Marcus L, Widemann B, Fox E, Chuk M, Balis F, Wells S, Stratakis CA. (111)In-octreotide scintigraphy for identification of metastatic medullary thyroid carcinoma in children and adolescents. J Clin Endocrinol Metab 2012; 97:E207-12. [PMID: 22162469 PMCID: PMC3275365 DOI: 10.1210/jc.2011-2766] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Most medullary thyroid cancers (MTC) express somatostatin receptors; therefore, (111)In-octreotide somatostatin receptor scintigraphy (SRS) may be useful in detecting sites of metastases in children with MTC. OBJECTIVE The aim of the study was to evaluate tumor metastases in children and adolescents with MTC using SRS in comparison to conventional imaging. DESIGN AND SETTING A case series was conducted as part of baseline evaluation for cancer treatment protocol at the National Institutes of Health Clinical Center. PATIENTS Eleven patients with a median age of 15 (range, 9-17) yr participated in the study, 10 with histologically proven, metastatic MTC due to the M918T mutation of the RET protooncogene, and one with a known RET polymorphism. INTERVENTION After receiving 0.086 mCi/kg (111)Indium-pentreotide, patients were examined with a single photon emission computed tomography scan 4 and 24 h after injection. Baseline conventional imaging, including computed tomography (neck, chest, abdomen, ± pelvis, adrenals), magnetic resonance imaging (neck), and bone scan, was performed on all patients. MAIN OUTCOME MEASURES SRS results were compared with conventional imaging. RESULTS Five of the 11 patients had abnormal findings on SRS. Of the 53 total target lesions present in the patients, only 24.5% were accurately identified through SRS. CONCLUSIONS SRS appears to be less sensitive than conventional imaging at detecting the full extent of metastatic disease in children and adolescents with hereditary MTC. SRS incompletely identified sites of tumor and failed to visualize small sites of tumor or liver and lung metastases, and it has a limited role in the evaluation of metastatic disease in pediatric MTC patients.
Collapse
Affiliation(s)
- Maya Lodish
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
Neuroendocrine tumors (NET) are a heterogeneous group of tumors that arise from neuroendocrine cells. These tumors may arise from various organs, including lung, thymus, thyroid, stomach, duodenum, small bowel, large bowel, appendix, pancreas, adrenal, and skin. Most are well differentiated and have the ability to produce biogenic amines and various hormones. NET usually occur sporadically but they also be associated with various familial syndromes. For the vast majority of NET, surgical resection is the treatment of choice whenever feasible. Localization of NET prior to surgery and for staging and follow-up relies on both anatomic and functional imaging modalities. In fact, the unique secretory characteristics of these tumors lend themselves to imaging by molecular imaging modalities, which can target specific metabolic pathways or receptors. Neuroendocrine cells have a variety of such target receptors and pathways for which radiopharmaceuticals have been developed, including [(123)I/(131)I]-metaiodobenzylguanidine (MIBG), [(111)In]pentetreotide, [(68)Ga] somatostatin analogs, [(18)F] fluorodeoxyglucose (FDG), [(11)C/(18)F] dihydroxyphenylalanine (DOPA), [(11)C] 5-hydroxytryptophan (5-HTP) (99m)Tc pentavalent dimercaptosuccinic acid ([(99m)Tc] (V) DMSA, and [(18)F] fluorodopamine (FDA). Here, we review the molecular imaging approaches for NET using various radiopharmaceuticals.
Collapse
Affiliation(s)
- Jorge A Carrasquillo
- Nuclear Medicine Service, Radiology Department Memorial Sloan-Kettering, New York, NY, USA.
| | | |
Collapse
|
11
|
Reidy-Lagunes DL, Gollub MJ, Saltz LB. Addition of Octreotide Functional Imaging to Cross-Sectional Computed Tomography or Magnetic Resonance Imaging for the Detection of Neuroendocrine Tumors: Added Value or an Anachronism? J Clin Oncol 2011; 29:e74-5. [DOI: 10.1200/jco.2010.32.8559] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
12
|
van Veelen W, de Groot JWB, Acton DS, Hofstra RMW, Höppener JWM, Links TP, Lips CJM. Medullary thyroid carcinoma and biomarkers: past, present and future. J Intern Med 2009; 266:126-40. [PMID: 19522831 DOI: 10.1111/j.1365-2796.2009.02106.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The clinical management of patients with persistent or recurrent medullary thyroid carcinoma (MTC) is still under debate, because these patients either have a long-term survival, due to an indolent course of the disease, or develop rapidly progressing disease leading to death from distant metastases. At this moment, it cannot be predicted what will happen within most individual cases. Biomarkers, indicators which can be measured objectively, can be helpful in MTC diagnosis, molecular imaging and treatment, and/or identification of MTC progression. Several MTC biomarkers are already implemented in the daily management of MTC patients. More research is being aimed at the improvement of molecular imaging techniques and the development of molecular systemic therapies. Recent discoveries, like the prognostic value of plasma calcitonin and carcino-embryonic antigen doubling-time and the presence of somatic RET mutations in MTC tissue, may be useful tools in clinical decision making in the future. In this review, we provide an overview of different MTC biomarkers and their applications in the clinical management of MTC patients.
Collapse
Affiliation(s)
- W van Veelen
- The Division of Biomedical Genetics, Department of Metabolic and Endocrine Diseases, University Medical Centre Utrecht, Utrecht.
| | | | | | | | | | | | | |
Collapse
|
13
|
Kloos RT, Eng C, Evans DB, Francis GL, Gagel RF, Gharib H, Moley JF, Pacini F, Ringel MD, Schlumberger M, Wells SA. Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid 2009; 19:565-612. [PMID: 19469690 DOI: 10.1089/thy.2008.0403] [Citation(s) in RCA: 759] [Impact Index Per Article: 50.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Inherited and sporadic medullary thyroid cancer (MTC) is an uncommon and challenging malignancy. The American Thyroid association (ATA) chose to create specific MTC Clinical Guidelines that would bring together and update the diverse MTC literature and combine it with evidence-based medicine and the knowledge and experience of a panel of expert clinicians. METHODS Relevant articles were identified using a systematic PubMed search and supplemented with additional published materials. Evidence-based recommendations were created and then categorized using criteria adapted from the United States Preventive Services Task Force, Agency for Healthcare Research and Quality. RESULTS Clinical topics addressed in this scholarly dialog included: initial diagnosis and therapy of preclinical disease (including RET oncogene testing and the timing of prophylactic thyroidectomy), initial diagnosis and therapy of clinically apparent disease (including preoperative testing and imaging, extent of surgery, and handling of devascularized parathyroid glands), initial evaluation and treatment of postoperative patients (including the role of completion thyroidectomy), management of persistent or recurrent MTC (including the role of tumor marker doubling times, and treatment of patients with distant metastases and hormonally active metastases), long-term follow-up and management (including the frequency of follow-up and imaging), and directions for future research. CONCLUSIONS One hundred twenty-two evidence-based recommendations were created to assist in the clinical care of MTC patients and to share what we believe is current, rational, and optimal medical practice.
Collapse
|
14
|
Czepczyński R, Parisella MG, Kosowicz J, Mikołajczak R, Ziemnicka K, Gryczyńska M, Sowiński J, Signore A. Somatostatin receptor scintigraphy using 99mTc-EDDA/HYNIC-TOC in patients with medullary thyroid carcinoma. Eur J Nucl Med Mol Imaging 2007; 34:1635-45. [PMID: 17530247 DOI: 10.1007/s00259-007-0479-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Accepted: 04/16/2007] [Indexed: 12/31/2022]
Abstract
PURPOSE Several new somatostatin analogues have been developed for the diagnosis and therapy of different tumours. Since somatostatin receptors are often over-expressed in medullary thyroid carcinoma (MTC), the aim of our study was to evaluate the utility of scintigraphy with the somatostatin analogue (99m)Tc-EDDA/HYNIC-TOC in MTC in comparison with other diagnostic techniques. METHODS Forty-five patients with MTC, aged 14-83 years, were investigated. Scintigraphy using (99m)Tc-EDDA/HYNIC-TOC (Tektrotyd) was performed 2 and 4 h post injection of 740 MBq (20 mCi) of the tracer. Other imaging techniques were also applied and analysed in individual cases (ultrasonography, computed tomography, (99m)Tc(V)-DMSA, (131)I-MIBG, (99m)Tc-MDP, (111)In-DTPA-octreotide and (18)F-FDG-PET) and compared with (99m)Tc-EDDA/HYNIC-TOC. RESULTS In group 1 (eight patients before thyroidectomy), uptake of the tracer was found in the primary tumours. In group 2 (six patients with remission), a false positive result was found in one patient; in the remaining five patients, no pathological foci were visualised. In group 3 (31 patients with post-surgical hypercalcitoninaemia), scintigraphy was true positive in 23 patients (74.2%): uptake in the thyroid bed was found in five patients, in the lymph nodes in 18 and in bone metastases in four. Using (99m)Tc-EDDA/HYNIC-TOC scintigraphy, the overall sensitivity was 79.5%, specificity 83.3%, accuracy 80.0%, positive predictive value 96.9% and negative predictive value 38.5%. CONCLUSION (99m)Tc-EDDA/HYNIC-TOC is clinically useful for scintigraphy in the follow-up of patients with MTC. It can be used in clinical practice for preoperative evaluation, for localisation of local recurrence or distant metastases and particularly for therapy decision making.
Collapse
Affiliation(s)
- Rafał Czepczyński
- Department of Endocrinology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznań, Poland.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Schott M, Willenberg HS, Sagert C, Nguyen TBT, Schinner S, Cohnen M, Cupisti K, Eisenberger CF, Knoefel WT, Scherbaum WA. Identification of occult metastases of medullary thyroid carcinoma by pentagastrin-stimulated intravenous calcitonin sampling followed by targeted surgery. Clin Endocrinol (Oxf) 2007; 66:405-9. [PMID: 17302876 PMCID: PMC1859979 DOI: 10.1111/j.1365-2265.2007.02747.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
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 18F-FDG 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.
Collapse
Affiliation(s)
- Matthias Schott
- Department of Endocrinology, Diabetes and Rheumatology, University Hospital Dusselsorf, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Traugott A, Moley JF. Medullary thyroid cancer: medical management and follow-up. Curr Treat Options Oncol 2006; 6:339-46. [PMID: 15967086 DOI: 10.1007/s11864-005-0037-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Medullary thyroid carcinoma (MTC) is a neuroendocrine malignancy that occurs in hereditary (25%) and sporadic (75%) clinical settings. MTC is present in all patients with the multiple endocrine neoplasia type 2 (MEN 2) syndromes. MTCs produce calcitonin, measurement of which indicates the presence of tumor in at-risk individuals and the effectiveness of therapy in treated patients. Surgery is the mainstay of therapy for primary and recurrent disease. Routine serial postoperative measurement of calcitonin levels should be done. Patients with elevated calcitonin levels should have imaging by computed tomography scan, magnetic resonance imaging, and/or fluorodeoxyglucose positron emission tomography to identify sites of recurrence and metastasis. The role of radiation therapy is not well defined. There is no effective systemic therapy for MTC at present. Activating mutations in a tyrosine kinase receptor gene are present in the majority of MTCs, and experience with tyrosine kinase inhibitors and other agents in the setting of clinical trials is critical for the identification of effective systemic treatment.
Collapse
Affiliation(s)
- Amber Traugott
- Washington University School of Medicine, Box 8109, 660 S Euclid Avenue, St. Louis, MO 63110, USA
| | | |
Collapse
|
17
|
Szavcsur P, Godény M, Bajzik G, Lengyel E, Repa I, Trón L, Boér A, Vincze B, Póti Z, Szabolcs I, Esik O. Angiography-proven liver metastases explain low efficacy of lymph node dissections in medullary thyroid cancer patients. Eur J Surg Oncol 2005; 31:183-90. [PMID: 15698736 DOI: 10.1016/j.ejso.2004.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2004] [Indexed: 11/20/2022] Open
Abstract
AIM To report the role of liver angiography in the staging of medullary thyroid cancer (MTC) patients. MATERIAL AND METHODS Sixty MTC patients with persistent or recurrent hypercalcitonemia (n=49), a characteristic general symptom (diarrhea, n=4) or a normal basal calcitonin level without general symptoms (n=7) were investigated by dynamic liver CT, MRI and angiography between 06/1998 and 06/2002. RESULTS Dual-phase CT and MRI investigations identified hepatic metastases with relatively low frequency (8/58 on MRI, and 7/60 on CT). Angiography indicated liver involvement in 54/60 cases. The hepatic metastases were typically multiple, hypervascular, small foci (only 13 foci measured >/=10 mm). With one exception significant disease progression was not observed over 5 years of follow-up. CONCLUSIONS Liver angiography is a powerful tool to reveal hepatic metastases in MTC patients. Frequent, inoperable liver metastases in hypercalcitoninemic MTC patients demonstrate that secondary lymph node dissection is an inefficient technique for restoration of a normal calcitonin level.
Collapse
Affiliation(s)
- P Szavcsur
- Department of Diagnostic Imaging, National Institute of Oncology, Budapest, Hungary
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Phan TTH, Jager PL, van Tol KM, Links TP. Thyroid cancer imaging. Cancer Treat Res 2004; 122:317-43. [PMID: 16209053 DOI: 10.1007/1-4020-8107-3_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- T T H Phan
- Department of Nuclear Medicine, University Hospital Groningen, Groningen, The Netherlands
| | | | | | | |
Collapse
|
19
|
Bockisch A, Brandt-Mainz K, Görges R, Müller S, Stattaus J, Antoch G. Diagnosis in medullary thyroid cancer with [18F]FDG-PET and improvement using a combined PET/CT scanner. ACTA MEDICA AUSTRIACA 2003; 30:22-5. [PMID: 12558562 DOI: 10.1046/j.1563-2571.2003.02045.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Today, positron emission tomography (PET) investigation using fluorodeoxyglucose (FDG) is the most sensitive and specific single modality established for localizing metastases of medullary thyroid cancer (MTC). Even at calcitonin serum levels below 20 pg/ml, tumour localization may be successful in individual cases. However, especially in such early tumour stages, the morphological correlation using PET is unsatisfactory. With the newly available fixed combination of PET and computed tomography (PET/CT), this drawback can be overcome as PET/CT allows a point-by-point correlation of pathological function with morphological structure. Conventional PET alone yielded an approx 80 % sensitivity and specificity in MTC: a result that will be surpassed by the combined PET/CT scanner.
Collapse
Affiliation(s)
- A Bockisch
- Department of Nuclear Medicine, University of Essen, Germany.
| | | | | | | | | | | |
Collapse
|
20
|
Zamir D, Polychuck I, Leibovitz I, Reitblat T, Ben-Horin C, Gheorghiu D, Santo M, Marmur S, Zamir C. Diarrhea and hypokalemia as primary manifestations of medullary carcinoma of the thyroid. Am J Med 2002; 113:438-9. [PMID: 12401542 DOI: 10.1016/s0002-9343(02)01217-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
21
|
�sik O, Szavcsur P, Szak�ll S, Bajzik G, Repa I, Dabasi G, F�zy M, Szentirmay Z, Perner F, K�sler M, Lengyel Z, Tr�n L. Angiography effectively supports the diagnosis of hepatic metastases in medullary thyroid carcinoma. Cancer 2001. [DOI: 10.1002/1097-0142(20010601)91:11<2084::aid-cncr1236>3.0.co;2-j] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
22
|
Modigliani E, Franc B, Niccoli-sire P. Diagnosis and treatment of medullary thyroid cancer. BAILLIERE'S BEST PRACTICE & RESEARCH. CLINICAL ENDOCRINOLOGY & METABOLISM 2000; 14:631-49. [PMID: 11289739 DOI: 10.1053/beem.2000.0107] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Medullary carcinoma of the thyroid (MTC) is a rare tumour derived from thyroid C cells with serum calcitonin as a specific and sensitive marker. MTC is inherited in 25% of cases, with an autosomal dominant transmission, age-related penetrance and variable expressivity. MTC is an obligatory component of multiple endocrine neoplasia type 2 (MEN2), which comprises three well defined syndromes: MEN2A, which may be associated with pheochromocytoma and/or hyperparathyroidism; the much rarer MEN2B, which occurs early and is accompanied by developmental abnormalities; while in contrast, familial MTC (FMTC) is not associated with any endocrinopathy. The RET proto-oncogene is the causative gene of the MEN2 syndromes and mutations in this gene are found in >90% of inherited cases, allowing easier and more reliable family screening than pentagastrin stimulation tests. Nevertheless, the correlation between the genotype and the different clinical phenotypes is not perfect. The prognosis of MTC depends on its staging at presentation, and the early appearance of cervical lymph node metastases emphasizes the need for extensive surgery, although many patients still do not normalize calcitonin levels post-operatively, and they remain a challenge for the further management.
Collapse
Affiliation(s)
- E Modigliani
- Groupe d'étude des tumeurs à calcitonine, Centre médical Europe, 75311 Paris, Cedex 09, France
| | | | | |
Collapse
|
23
|
Machens A, Gimm O, Ukkat J, Hinze R, Schneyer U, Dralle H. Improved prediction of calcitonin normalization in medullary thyroid carcinoma patients by quantitative lymph node analysis. Cancer 2000. [DOI: 10.1002/(sici)1097-0142(20000415)88:8<1909::aid-cncr21>3.0.co;2-a] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
24
|
Abstract
INTRODUCTION Medullary thyroid carcinoma is a rare disease which originates from the secretion of calcitonin by thyroid parafollicular cells. Sporadic (75%) and inherited (25%) forms of the disease are encountered. Familial forms (termed multiple endocrine neoplasia type IIa, IIb, or familial medullary thyroid carcinoma) may or may not be associated with other endocrinopathies such as pheochromocytoma and/or hyperparathyroidism. CURRENT KNOWLEDGE AND KEY POINTS Circulating forms of calcitonin, a marker of the disease, are heterogeneous in blood, thus explaining why assays lead to different results according to the method used. FUTURE PROSPECT AND PROJECTS Family screening is much easier, as germ line mutations of the proto-oncogene RET have recently been identified in inherited forms of the disease. Treatment includes extensive surgery. This, and prophylactic thyroidectomy in gene carriers, is discussed. Prognosis is much better nowadays, but precise follow-up has to be instituted.
Collapse
Affiliation(s)
- E Modigliani
- Service d'endocrinologie, hôpital Avicenne, Bobigny, France
| |
Collapse
|
25
|
Krausz Y, Rosler A, Guttmann H, Ish-Shalom S, Shibley N, Chisin R, Glaser B. Somatostatin receptor scintigraphy for early detection of regional and distant metastases of medullary carcinoma of the thyroid. Clin Nucl Med 1999; 24:256-60. [PMID: 10466522 DOI: 10.1097/00003072-199904000-00008] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Three patients are described who had regional and distant metastases of medullary thyroid cancer detected by somatostatin receptor scintigraphy but not by CT; two had minimal disease that was amenable to surgery. The first patient had been followed for 2 years before having a repeated scan and positive CT, with subsequent surgical removal of metastatic paratracheal nodes. The plasma calcitonin level, however, did not approach normal values after surgery, and a third scan showed persistence of focal uptake in the left paratracheal area of the lower neck, whereas CT was negative. At repeated exploration, a tumor mass of medullary carcinoma, embedded in lymphatic tissue, was removed. Nine months after the last surgical procedure, calcitonin and carcinoembryonic antigen levels were normal. The second patient underwent microdissection of the mediastinum and removal of two metastatic nodes that were demonstrable only by the scintigraphic technique. The plasma calcitonin level subsequently became normal. The third patient, with multiple endocrine neoplasia IIB and associated pheochromocytoma, had bony metastatic involvement of the left shoulder, demonstrable initially on somatostatin receptor scintigraphy and subsequently with radioiodinated metaiodobenzylguanidine but not on CT.
Collapse
Affiliation(s)
- Y Krausz
- Department of Nuclear Medicine, Hadassah University Hospital, Jerusalem, Israel
| | | | | | | | | | | | | |
Collapse
|
26
|
James C, Starks M, MacGillivray DC, White J. The Use of Imaging Studies in the Diagnosis and Management of Thyroid Cancer and Hyperparathyroidism. Surg Oncol Clin N Am 1999. [DOI: 10.1016/s1055-3207(18)30230-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
27
|
|
28
|
Frendo JL, Delage-Mourroux R, Cohen R, Pichaud F, Pidoux E, Guliana JM, Jullienne A. Calcitonin receptor mRNA is expressed in human medullary thyroid carcinoma. Thyroid 1998; 8:141-7. [PMID: 9510122 DOI: 10.1089/thy.1998.8.141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We recently reported the presence of a truncated form (h-CTR2) of the human calcitonin receptor (CTR) in TT cells, a cell line derived from medullary thyroid carcinoma (MTC). This form (h-CTR2), characterized by the absence of 16 amino acids in the first intracellular domain, was also detected in two cases of MTC. In the present study we determined the expression of CTR mRNA in a larger sample, representative of the different clinical forms of MTC, and in normal thyroid. h-CTR2 was expressed in all MTC specimens (both sporadic and familial) and in the normal thyroid samples. The expression of the receptor mRNA was higher in MTC compared with normal thyroid. Moreover, CT and CTR mRNA levels were modified significantly during proliferation. This result suggests that CT may be involved in proliferation of MTC via autocrine/paracrine regulation. Calcitonin secretion by MTC may play a role in the development and spread of these tumors.
Collapse
Affiliation(s)
- J L Frendo
- Institut National de la Santé et de la Recherche Médicale, U.349, Hôpital Lariboisière, Centre Viggio Petersen, Paris, France
| | | | | | | | | | | | | |
Collapse
|
29
|
|
30
|
Gimm O, Dralle H. Reoperation in metastasizing medullary thyroid carcinoma: is a tumor stage-oriented approach justified? Surgery 1997; 122:1124-30; discussion 1130-1. [PMID: 9426428 DOI: 10.1016/s0039-6060(97)90217-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Lymph node metastases (LNM) are very often found in medullary thyroid carcinoma. After primary therapy, elevated levels of calcitonin are measurable in many patients. Because of the low sensitivity and specificity of diagnostic tools to detect micrometastases, the question remains whether an extended lymphadenectomy improves the chance of cure and whether this approach should be tumor stage oriented. METHODS We analyzed the results of 36 patients with medullary thyroid carcinoma consecutively reoperated from 1988 to 1996, performing microdissection of all four locoregional lymph node compartments. RESULTS Pathologic tumor stage (pT) category was classified as pT1, n = 3; pT2 n = 22; pT3, n = 6; and pT4, n = 5. LNM were found in 34 patients (94%). The cervicocentral compartment contained LNM in 85%, the cervicolateral compartments in 41% to 54%, and the upper mediastinum in 36%. Patients with different pT category did not differ in the rate of LNM. Ipsilateral cervicolateral LNM were found in 50% to 71% and contralateral cervicolateral LNM in 14% to 40%. Nine (35%) of 26 patients without distant metastases were biochemically cured. In 10 patients (38%) calcitonin level decreased more than 50%. CONCLUSIONS LNM were almost always (94%) found in patients who have elevated calcitonin levels after primary therapy. In patients without distant metastases, four-compartment lymphadenectomy gives a chance of cure in 35%. A tumor stage-oriented approach does not seem to be justified.
Collapse
Affiliation(s)
- O Gimm
- Department of General Surgery, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | | |
Collapse
|
31
|
Behr TM, Gratz S, Markus PM, Dunn RM, Hüfner M, Becker H, Becker W. Enhanced bilateral somatostatin receptor expression in mediastinal lymph nodes ("chimney sign") in occult metastatic medullary thyroid cancer: a typical site of tumour manifestation? EUROPEAN JOURNAL OF NUCLEAR MEDICINE 1997; 24:184-91. [PMID: 9021116 DOI: 10.1007/bf02439551] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In medullary thyroid cancer (MTC), post-surgically elevated plasma calcitonin and/or carcinoembryonic antigen levels frequently indicate persisting metastatic disease, although conventional diagnostic procedures fail to localize the responsible lesions (occult disease). Somatostatin analogues have been used successfully in disease localization, but recently concerns have been raised that increased thoracic uptake of indium-111 pentetreotide in patients with previous external beam irradiation may represent a false-positive finding, caused by post-irradiation pulmonary fibrosis. We recently examined seven patients with metastatic MTC by somatostatin receptor scintigraphy (six with occult and one with established disease). In four patients, all of whom had stable or slowly rising tumour marker levels over several years, a chimney-like bilateral mediastinal uptake of indium-111 pentetreotide was found. In two patients with persisting hypercalcitonaemia immediately after primary surgery, supraclavicular lymph node metastases were identified as the responsible lesions. None of these seven patients had prior external beam radiation therapy. In two cases, histological confirmation was obtained. In one patient, disease progression could be shown during follow-up. These data suggest that bilateral mediastinal lymph node involvement is a typical site of disease in slowly progressing occult metastatic MTC; the "chimney sign" may represent a typical finding with somatostatin analogues in such cases. Therefore, we believe that even in the case of prior external beam irradiation, mediastinal uptake of octreotide might represent metastatic MTC rather than radiation fibrosis.
Collapse
Affiliation(s)
- T M Behr
- Department of Nuclear Medicine, Georg-August-University of Göttingen, Germany
| | | | | | | | | | | | | |
Collapse
|
32
|
Rendl J, Reiners C. Follow-up of patients with medullary thyroid carcinoma. Eur Surg 1997. [DOI: 10.1007/bf02620269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
33
|
Medullary thyroid cancer — Reoperation. Eur Surg 1997. [DOI: 10.1007/bf02620268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
34
|
Abstract
No ideal imaging method is available for the diagnosis of MTC. Once the diagnosis is suspected, serum calcitonin or CEA may help to confirm it. Often, multiple studies are done, especially a combination of MR imaging or ultrasound and an isotopic method. Tc(V)DMSA is an excellent agent but not readily available in the United States. Indium-labeled pentreotide is probably the imaging agent of choice in the United States.
Collapse
Affiliation(s)
- R J Galloway
- Division of Medicine, Walter Reed Army Institute of Research, Washington, DC, USA
| | | |
Collapse
|
35
|
Grauer A, Schroth J, Ziegler R, Raue F. Evaluation of somatostatin as a plasma tumor marker in medullary thyroid carcinoma. Thyroid 1995; 5:287-91. [PMID: 7488870 DOI: 10.1089/thy.1995.5.287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Somatostatin (SRIF) immunoreactivity has been frequently reported in tumor tissues of cell types, belonging to the APUD system, including medullary thyroid carcinoma (MTC). However, the value of SRIF as a plasma tumor marker for MTC is controversial. We have measured SRIF plasma levels in 35 patients with different stages of MTC to evaluate the use of SRIF as a plasma tumor marker compared to the current "gold standard" calcitonin (CT). The median SRIF value in healthy controls was 36.5 pg/mL, the upper limit of normal was defined at the controls. The median value was 28 pg/mL (p = 0.37, Mann-Whitney U test). Five patients in the control group and three in the MTC group had SRIF levels that exceed the 95th percentile. SRIF and CT levels correlated only weakly (0.38), as determined by the Spearman rank order correlation test. Pentagastrin stimulation led to a diagnostic increase in SRIF levels in only one of five MTC patients. During selective venous catheterization, diagnostic gradients for CT, allowing tumor localization, could be demonstrated, whereas measurement of SRIF levels did not aid in tumor detection. Although SRIF immunostaining may be valuable as an additional marker in the histochemical diagnosis of MTC, SRIF has no value as a plasma tumor marker in the diagnosis of this disease.
Collapse
Affiliation(s)
- A Grauer
- Department of Internal Medicine I, Endocrinology and Metabolism, University of Heidelberg, Germany
| | | | | | | |
Collapse
|