Improved selection of patients for reoperation for medullary thyroid cancer by imaging with radiolabeled anticarcinoembryonic antigen antibodies.
BACKGROUND
This study examined the utility of using radiolabeled anticarcinoembryonic antigen (CEA) monoclonal antibodies (MAbs) as a noninvasive imaging method to aid in the selection of patients for reoperation after operation for medullary thyroid carcinoma (MTC).


METHODS
Sixteen patients with persistent or recurrent hypercalcitoninemia since operation or MTC, but had negative or equivocal conventional imaging study results, were given 99mTc-, 123I-, or 131I-labeled NP-4 or MN-14 anti-CEA MAbs. Scintigraphic images were then performed to determine detection of tumor lesions.


RESULTS
The MAb scans were positive in 13 (81%) of the 16 patients studied. However, in only three of 13 patients was disease confined to the cervical or mediastinal nodes. In 10 patients, disease was additionally or solely found in distant organs such as liver (five patients), bone (four patients), and periaortic nodes (one patient). On the basis of our studies, only three of the 13 patients with positive scans would benefit from repeat neck exploration, another three would possibly benefit from neck or mediastinal exploration and hepatic resection, and the remaining seven patients would not benefit from any reoperation with curative intent.


CONCLUSIONS
MTC imaging with anti-CEA MAbs could be very useful in determining the ideal candidates for repeat neck exploration.
Juweid
M
M
Garden State Cancer Center, Belleville, NJ 07109, USA.
Sharkey
R M
RM
Swayne
L C
LC
Goldenberg
D M
DM
D000328:Adult; D000368:Aged; D000818:Animals; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000276:immunology; D002272:Carcinoembryonic Antigen / Q000276:immunology*; D018276:Carcinoma, Medullary / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D051379:Mice; D008875:Middle Aged; D016719:Radioimmunodetection; D012086:Reoperation; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed
D000911:Antibodies, Monoclonal; D002272:Carcinoembryonic Antigen