Angiography effectively supports the diagnosis of hepatic metastases in medullary thyroid carcinoma.
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. (18)F-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 < or = 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.
Esik
O
O
Department of Radiotherapy, Semmelweis University, National Institute of Oncology, Budapest, Hungary. esik@oncol.hu
Szavcsur
P
P
Szakáll
S
S
Bajzik
G
G
Repa
I
I
Dabasi
G
G
Füzy
M
M
Szentirmay
Z
Z
Perner
F
F
Kásler
M
M
Lengyel
Z
Z
Trón
L
L
D000328:Adult; D000368:Aged; D000792:Angiography; D002116:Calcitonin / Q000097:blood; D018276:Carcinoma, Medullary / Q000175:diagnosis / Q000556:secondary*; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000209:etiology; D005260:Female; D019788:Fluorodeoxyglucose F18; D005483:Flushing / Q000209:etiology; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary*; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging / Q000379:methods; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D013964:Thyroid Neoplasms / Q000473:pathology*; D014055:Tomography, Emission-Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D002116:Calcitonin