title: Somatostatin receptor scintigraphy for early detection of regional and distant metastases of medullary carcinoma of the thyroid.
abstract: Three patients are described who had regional and distant metastases of medullary thyroid cancer detected by somatostatin receptor scintigraphy but not by CT; two had minimal disease that was amenable to surgery. The first patient had been followed for 2 years before having a repeated scan and positive CT, with subsequent surgical removal of metastatic paratracheal nodes. The plasma calcitonin level, however, did not approach normal values after surgery, and a third scan showed persistence of focal uptake in the left paratracheal area of the lower neck, whereas CT was negative. At repeated exploration, a tumor mass of medullary carcinoma, embedded in lymphatic tissue, was removed. Nine months after the last surgical procedure, calcitonin and carcinoembryonic antigen levels were normal. The second patient underwent microdissection of the mediastinum and removal of two metastatic nodes that were demonstrable only by the scintigraphic technique. The plasma calcitonin level subsequently became normal. The third patient, with multiple endocrine neoplasia IIB and associated pheochromocytoma, had bony metastatic involvement of the left shoulder, demonstrable initially on somatostatin receptor scintigraphy and subsequently with radioiodinated metaiodobenzylguanidine but not on CT.
authors.affiliation: Department of Nuclear Medicine, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Krausz
authors.forename: A
authors.initials: A
authors.lastname: Rosler
authors.forename: H
authors.initials: H
authors.lastname: Guttmann
authors.forename: S
authors.initials: S
authors.lastname: Ish-Shalom
authors.forename: N
authors.initials: N
authors.lastname: Shibley
authors.forename: R
authors.initials: R
authors.lastname: Chisin
authors.forename: B
authors.initials: B
authors.lastname: Glaser
mesh_terms: D019797:3-Iodobenzylguanidine; D000310:Adrenal Gland Neoplasms / Q000473:pathology; D000328:Adult; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D002116:Calcitonin / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D018276:Carcinoma, Medullary / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007205:Indium Radioisotopes; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D018814:Multiple Endocrine Neoplasia Type 2b / Q000473:pathology; D015282:Octreotide / Q000031:analogs & derivatives*; D010673:Pheochromocytoma / Q000473:pathology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017481:Receptors, Somatostatin / Q000032:analysis*; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014132:Trachea
chemical_list: D002272:Carcinoembryonic Antigen; D007205:Indium Radioisotopes; D019275:Radiopharmaceuticals; D017481:Receptors, Somatostatin; C094279:indium-111-octreotide; D019797:3-Iodobenzylguanidine; D002116:Calcitonin; D015282:Octreotide