Angiography effectively supports the diagnosis of hepatic metastases in medullary thyroid carcinoma

Abstract

BACKGROUND Medullary thyroid carcinoma (MTC) belongs in the group of neuroendocrine tumors with early lymphatic and hepatic dissemination. A high rate of undetectable metastases is hypothesized to be responsible for the frequent mismatch between the apparent relatively small tumor burden and the elevated plasma tumor marker level. METHODS Thirty‐six MTC patients with residual/recurrent biochemical signs (elevated basal calcitonin level) and/or characteristic general symptoms (diarrhea and/or flushing) were systematically examined by conventional radiology, whole‐body 18F‐deoxyglucose positron emission tomography (PET), dynamic liver computed tomography and magnetic resonance imaging, and hepatic angiography. RESULTS Conventional diagnostic imaging revealed lymph node (LN) involvement in the cervical, mediastinal, supraclavicular, and axillary regions (16 cases), and multiple pulmonary (3 cases), bony (1 solitary and 1 multiple case), and breast (1 case) metastases. 18F‐deoxyglucose PET identified all these extralymphatic metastatic lesions (except 2 cases with multiple pulmonary metastases), and also supradiaphragmatic LN involvement in 34 (94%) patients. In 32 (89%) cases, multiple small (generally ≤ 1 cm) hypervascular, hepatic metastases undetectable by other imaging methods were localized angiographically. Of the 23 original pathologic specimens investigated, 18 (78%) exhibited LN involvement. The smallest primary tumor in patients with hepatic metastases was 1 cm. CONCLUSIONS Hepatic angiography is recommended for primary staging in MTC patients with a primary tumor measuring 1 cm or larger, and/or pathologically proven LN involvement, and also during restaging for suspected recurrences to avoid unnecessary extensive surgical LN dissection in the neck and mediastinum. Cancer 2001;91:2084–95. © 2001 American Cancer Society.

Sensitivity and Prognostic Value of Positron Emission Tomography with F-18-Fluorodeoxyglucose and Sensitivity of Immunoscintigraphy in Patients with Medullary Thyroid Carcinoma Treated with Anticarcinoembryonic Antigen-Targeted Radioimmunotherapy

“…Indeed, Simeone et al (33) reported a 96% sensitivity and 83% specificity. Moreover, because our gold standard included imaging follow-up, sensitivity of CT for liver exploration should be probably lower if patients had undergone hepatic arteriography, MRI, or laparoscopic liver biopsy, which showed higher sensitivity than CT in previous studies (14,34).…”

How has the management of medullary thyroid carcinoma changed with the advent of 18F-FDG and non-18F-FDG PET radiopharmaceuticals

“…If Ct is more than 400 pg/ml then multiphase CT liver protocol, contrast-enhanced MRI of the liver, MRI of the spine, bone scintigraphy, and 18 F-FDG PET may be considered [3,8,10,11]. The insensitivity of imaging has been attributed to small hypervascular hepatic metastases detected only on hepatic arteriography in a significant number of patients [16,17], which in one study reached 89% [34]. Therefore, the use of staging laparoscopy to detect surface metastases, hepatic venous sampling, and hepatic angiography has been previously investigated; however, all of these techniques should be used sparingly.…”

Advances in the management of hereditary medullary thyroid cancer

“…Normalization of serum calcitonin, for the most part, is not feasible when more than two lymph node compartments, or 10 and more lymph nodes, are involved, presumably due to the presence of distant metastases [54, 57, 59]. Occasionally, occult distant metastases can be localized with the use of invasive procedures, namely venous cathetherization [68–70], thoracoscopy, laparoscopy [71], hepatic angiography [72] and radioimmunoguided surgery [73].…”