Abstract
Background
Surgery is the only potential cure for patients with medullary thyroid carcinoma (MTC). Preoperative ultrasound, computed tomography and magnetic resonance imaging are not sensitive enough for detection of microscopic disease. The aim of this study was to investigate if routine preoperative 111In-labelled (DTPA-D-Phe1)-octreotide scintigraphy (SRS) could be used as a staging procedure in planning primary surgery in patients with MTC.
Methods
This study included patients with primary sporadic clinically overt MTC diagnosed between 1996 and 2009. All patients underwent conventional imaging of neck and thorax and SRS prior to standardised surgery. The findings on SRS were correlated to the findings on conventional imaging, histopathology and to postoperative biochemical results and survival.
Results
A total of 19 patients with sporadic MTC were enrolled. Median follow-up was 77(9–184) months. SRS visualised the primary tumour in 16 (84 %) patients. Fifteen (79 %) patients had locoregional lymph node metastases, but SRS detected metastatic lesions in only 8 (53 %) patients. In three patients with distant spread, SRS failed to detect metastatic lesions in two. At latest follow-up, six (32 %) patients had died, nine (47 %) patients were alive with elevated tumour markers, and four (21 %) patients were considered in complete biochemical remission.
Conclusions
This study provided further evidence that SRS, compared to conventional imaging, is fairly sensitive for detection of primary MTC but not metastatic disease. Although preoperative SRS may be of prognostic value, there is no indication for its routine use as a staging procedure in planning primary surgery.
Similar content being viewed by others
References
Moley JF, DeBenedetti MK (1999) Patterns of nodal metastases in palpable medullary thyroid carcinoma: recommendations for extent of node dissection. Ann Surg 6:880–887
Fleming JB, Lee JE, Bouvet M et al (1999) Surgical strategy for the treatment of medullary thyroid carcinoma. Ann Surg 5:697–707
Gimm O, Ukkat J, Dralle H (1998) Determinative factors of biochemical cure after primary and reoperative surgery for sporadic medullary thyroid carcinoma. World J Surg 6:562–567
Machens A, Hauptmann S, Dralle H (2007) Increased risk of lymph node metastasis in multifocal hereditary and sporadic medullary thyroid cancer. World J Surg 10:1960–1965
Busnardo B, Girelli NE, Simioni N et al (1984) Nonparallel patterns of calcitonin and carcinoembryonic antigen levels in the follow-up of medullary thyroid carcinoma. Cancer 53:278–285
Papotti M, Kumar U, Volante M et al (2001) Immunohistochemical detection of somatostatin receptor types 1–5 in medullary carcinoma of the thyroid. Clin Endocrinol 5:641–649
Tisell LE, Ahlman H, Wängberg B et al (1997) Somatostatin receptor scintigraphy in medullary thyroid carcinoma. Br J Surg 4:543–547
Kaltsas G, Rockall A, Papadogias D et al (2004) Recent advances in radiological and radionuclide imaging and therapy of neuroendocrine tumours. Eur J Endocrinol 1:15–27
Baudin E, Lumbroso J, Schlumberger M et al (1996) Comparison of octreotide scintigraphy and conventional imaging in medullary thyroid carcinoma. J Nucl Med 6:912–916
Kwekkeboom DJ, Reubi JC, Lamberts SW et al (1993) In vivo somatostatin receptor imaging in medullary thyroid carcinoma. J Clin Endocrinol Metab 6:1413–1417
Dörr U, Frank-Raue K, Raue F et al (1993) The potential value of somatostatin receptor scintigraphy in medullary thyroid carcinoma. Nucl Med Commun 6:439–445
Lodish M, Dagalakis U, Chen CC et al (2012) (111)In-octreotide scintigraphy for identification of metastatic medullary thyroid carcinoma in children and adolescents. J Clin Endocrinol Metab 2:207–212
TNM classification of malignant tumours (2009) Wiley-Liss, New York
Faggiano A, Grimaldi F, Pezzullo L et al (2009) Secretive and proliferative tumour profile helps to select the best imaging technique to identify postoperative persistent or relapsing medullary thyroid cancer. Endocr Relat Cancer 1:225–231
Giraudet AL, Vanel D, Leboulleux S et al (2007) Imaging medullary thyroid carcinoma with persistent elevated calcitonin levels. J Clin Endocrinol Metab 11:4185–4190
Reubi JC, Krenning E, Lamberts SW et al (1992) In vitro detection of somatostatin receptors in human tumours. Metabolism 9(Suppl 2):104–110
Christian JA, Cook GJ, Harmer C (2003) Indium-111-labelled octreotide scintigraphy in the diagnosis and management of non-iodine avid metastatic carcinoma of the thyroid. Br J Cancer 2:258–261
Mato E, Matías-Guiu X, Chico A et al (1998) Somatostatin and somatostatin receptor subtype gene expression in medullary thyroid carcinoma. J Clin Endocrinol Metab 7:2417–2420
Forssell-Aronsson EB, Nilsson O, Bejegård SA et al (2000) 111In-DTPA-D-Phe1-octreotide binding and somatostatin receptor subtypes in thyroid tumours. J Nucl Med 4:636–642
Reubi JC, Chayvialle JA, Franc B et al (1991) Somatostatin receptors and somatostatin content in medullary thyroid carcinomas. Lab Invest 4:567–573
Behr TM, Gratz S, Markus PM et al (1997) Anti-carcinoembryonic antigen antibodies versus somatostatin analogues in the detection of metastatic medullary thyroid carcinoma: are carcinoembryonic antigen and somatostatin receptor expression prognostic factors? Cancer 80(12 Suppl):2436–2457
Grebe SKG, Hay ID (1996) Thyroid nodal metastases, biologic significance and therapeutic considerations. Surg Oncol Clin North Am 5:43–64
Tisell LE, Oden A, Muth A et al (2003) The Ki67 index a prognostic marker in medullary thyroid carcinoma. Br J Cancer 11:2093–2097
Reubi JC, Waser B (1996) Unexpected high incidence of cholecystokinin-B/gastrin receptors in human medullary thyroid carcinomas. Int J Cancer 5:644–647
Gotthardt M, Béhé MP, Beuter D et al (2006) Improved tumour detection by gastrin receptor scintigraphy in patients with metastasised medullary thyroid carcinoma. Eur J Nucl Med Mol Imaging 11:1273–1279
Fröberg AC, de Jong M, Nock BA et al (2009) Comparison of three radiolabelled peptide analogues for CCK-2 receptor scintigraphy in medullary thyroid carcinoma. Eur J Nucl Med Mol Imaging 8:1265–1272
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dahlberg, J., Bümming, P., Gjertsson, P. et al. Routine preoperative 111In-octreotide scintigraphy in patients with medullary thyroid cancer. Langenbecks Arch Surg 398, 875–880 (2013). https://doi.org/10.1007/s00423-013-1086-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-013-1086-1