Abstract
To evaluate the use of pretargeted immunoscintigraphy (ISG) in the diagnosis and follow-up of patients with medullary thyroid carcinoma (MTC), we studied 25 patients with histologically proven disease; ISG was repeated after surgery in two patients. The antibody, either an anticarcinoembryonic antigen (CEA) or an antichromogranin A (CgA) biotinylated monoclonal antibody (MAb) or a cocktail of the two biotinylated MAbs was first injected. After 24 h, avidin was administrated i.v., followed by 111In-labelled biotin 24 h later. Fifty-two lesions were visualised. Six primary tumours, diagnosed by increased calcitonin levels, were all correctly diagnosed; 47 recurrences, also suspected by blood tumour markers, were detected and confirmed by cytology or histology. In one case, single photon emission tomography allowed the detection of small lymph nodes with a diameter of 4-7 mm. These lesions, not judged neoplastic by ultrasound, were confirmed to be neoplastic by fine needle aspiration. Pretargeted ISG correctly localises primary tumours and recurrences in MTC patients, when the only marker of relapse is serum elevation of calcitonin. With this three-step pretargeting method, cocktails of potentially useful MAbs can be used, avoiding false-negative studies that may occur when CEA or CgA are not expressed.
Highlights
This paper reports the evaluation of pretargeted immunoscintigraphy (ISG) in the diagnosis of primary/metastatic and recurrent medullary thyroid carcinoma (MTC)
A continuous sequence of 25 patients attending endocrine and oncological clinics in various Italian cities and with a clinical diagnosis of MTC were enrolled in the study, which was approved by the Scientific Institute HS Raffaele Ethics Committee
Six patients had primary tumour diagnosed by biochemical data and a family history of MTC
Summary
A continuous sequence of 25 patients attending endocrine and oncological clinics in various Italian cities and with a clinical diagnosis of MTC (ten female, 15 male; 18-68 years of age) were enrolled in the study, which was approved by the Scientific Institute HS Raffaele Ethics Committee. Before entering the study all patients gave written informed consent. Six patients had primary tumour diagnosed by biochemical data and a family history of MTC. Eighteen patients had biochemical evidence of recurrence and one patient had US evidence of a thyroid remnant with. Importance of ultrasound examination for the follow-up of medullary thyroid carcinoma: comparison with other localization methods.
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