Schl ü sselw ö rter • ▶ Thyreoglobulin (hTg) • ▶ Kalzitonin (hCt) • ▶ diff erenziertes Schilddr ü senkarzinom • ▶ medull ä res Schilddr ü senkarzinom • ▶ Nachsorge • ▶ Schilddr ü senknoten Key words • ▶ thyroglobulin (hTg) • ▶ calcitonin (hCt) • ▶ diff erentiated thyroid cancer • ▶ medullary thyroid cancer • ▶ restaging • ▶ thyroid nodule Zusammenfassung & Thyreoglobulin (hTg) bzw. Kalzitonin (hCt) sindetablierte humorale Tumormarker f ü r die Therapie ü berwachung und Nachsorge der behandelten thyreoidalen Follikelzell-bzw. C-Zell-Karzinome. Hierf ü r besitzen diese Analyten eine im Vergleich zu vielen anderen Tumormarkern hohe diagnostische Spezifi t ä t, die mit dem Ausma ß der Radikalit ä t der Schilddr ü senablation zunimmt. In den letzten Jahren werden Assays mit zunehmender funktioneller Sensitivit ä t angeboten, die allerdings mit neuen Herausforderungen an die labortechnische Durchf ü hrung, die Qualit ä tssicherung sowie die Interpretation der im " ultrasensitiven " Bereich messbaren Werte einhergehen. Ohnehin sind hTg und hCt als relativ anspruchsvolle Laborparameter anzusehen. Die Messergebnisse sind zum Teil deutlich abh ä ngig von diversen In-vivo-und In-vitro-Einfl ussfaktoren, aber auch bei konstanten Rahmenbedingungen ist die Vergleichbarkeit der gemessenen Werte zwischen verschiedenen As says nicht ohne weiteres garantiert. Hinsichtlich der hCt-Bestimmung bieten Assays mit weitgehend selektiver Erfassung der monomeren (reifen) Kalzitoninform den Vorteil einer weiteren Steigerung der diagnostischen Spezifi t ä t. Abgesehen von der Ü berwachung der wegen eines Schilddr ü senkarzinom behandelten Patienten wird die hCt-Bestimmung von zahlreichen Fachgesellschaften auch bei der Dignit ä tsabkl ä rung thyreoidaler Raumforderungen als gerechtfertigt angesehen, wohingegen die hTg-Bestimmung nicht als Routinema ß nahme zur Schilddr ü senknotenabkl ä rung in die Leitlinien aufgenommen wurde. Die hTg-Bestimmung kann aber bei der Evaluierung bestimmter benigner Schilddr ü senprozesse indiziert sein wie der Diff erenzialdiagnose der konnatalen Hypothyreose, der Abkl ä rung einer vermuteten faktitiellen Hyperthyreose oder als Aktivit ä tsmarker f ü r destruierende Schilddr ü senprozesse wie der subakuten oder Amiodaron-induzierten Thyreoiditis. Abstract &Thyroglobulin and calcitonin are established humoral tumor markers for therapy monitoring and follow up of thyroid cancer of follicular origin or medullary thyroid cancer, respectively. In comparison to many other tumor markers these analytes off er a high diagnostic specifi city, which increases with the radicalness of thyroid ablation. Over the last years, assays with rising functional sensitivity became commercially available, being however a challenge in respect to laboratory performance, quality assurance and medical judgement in the " ultrasensitive " range of detectable concentrations. Anyway, hTg and hCT must be considered to be ambitious laboratory parameters. The results considerably depend on various in vivo and in vitro infl uences, and even under...
The somatostatin analogue octreotide is effective in the treatment of neuroendocrine and other tumours. 111 -In-labelled DTPA-octreotide scintigraphy is successful in localizing primary neuroendocrine tumours and metastases and other tumours containing somatostatin receptors. An antiproliferative effect of octreotide was also demonstrated for colorectal carcinoma. Since only about 40% of colorectal carcinomas express somatostatin receptors, we tried to establish whether 111 -In-labelled DTPA-octreotide scintigraphy is able to reveal the receptor status of liver metastases in patients with colorectal liver metastases. This would be useful in selecting patients for adjuvant therapy studies with octreotide. We performed 111 -In-labelled DTPA-octreotide scintigraphy in ten patients with nonresectable liver metastases of colorectal origin and curatively resected primary. In nine of ten patients the liver metastases were somatostatin receptor negative, in one patient somatostatin receptor positive. In the patient with somatostatin receptor-positive liver metastases after resection of a rectal carcinoma, the histological examination of the biopsies from the liver metastases showed a solid tumour of neuroendocrinal differentiation. In the repeated histological examination of the specimen of the rectal primary, a small solid tumour with neuroendocrinal differentiation was found between formations of adenocarcinoma (adenoendocrine carcinoma). In our study 111 -In-labelled DTPA-octreotide scintigraphy did not indicate the receptor status of liver metastases from colorectal carcinoma and was not useful in the planning of therapeutic regimens. For the diagnosis of the receptor status of colorectal liver metastases autoradiographic investigation on tissue biopsies are still necessary. In patients with adenoendocrine carcinomas 111 -In-labelled DTPA-octreotide scintigraphy may help to histologically differentiate the metastases.
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