title: The value of intraoperative pentagastrin testing in medullary thyroid cancer.
abstract: BACKGROUND
  The decrease of calcitonin levels after curative operation in patients with medullary thyroid cancer is characterized by individual variation; therefore, intraoperative calcitonin measurements to evaluate the completeness of the resection seem to not be feasible. The aim of this study was to evaluate whether an intraoperative pentagastrin test after thyroidectomy and central neck dissection is useful to predict lymph node involvement of the lateral neck.
  
  
  METHODS
  A group of 30 consecutive patients underwent primary surgery. After thyroidectomy and dissection of the central lymph node compartment, an intraoperative pentagastrin test was performed. Biochemical and histologic data were compared retrospectively.
  
  
  RESULTS
  Of the group, 20 patients (67%) showed no, or only central neck lymph node, involvement and no increase in calcitonin after intraoperative stimulation. Lymph node involvement was documented histologically in the lateral neck of 10 patients (33%), and 8 patients showed an increase of calcitonin as an indication of lymph node involvement. In two patients, each with 1 single micrometastasis in the lateral neck, the intraoperative pentagastrin test was negative.
  
  
  CONCLUSIONS
  Intraoperative calcitonin monitoring after pentagastrin stimulation seems promising in predicting lymph node involvement of the lateral neck to aid selection of patients for lateral lymph node dissection. The development of a highly sensitive, quick calcitonin assay is imperative.
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria. christian.scheuba@meduniwien.ac.at
authors.forename: Christian
authors.initials: C
authors.lastname: Scheuba
authors.forename: Christian
authors.initials: C
authors.lastname: Bieglmayer
authors.forename: Reza
authors.initials: R
authors.lastname: Asari
authors.forename: Klaus
authors.initials: K
authors.lastname: Kaczirek
authors.forename: Barbara
authors.initials: B
authors.lastname: Izay
authors.forename: Klaus
authors.initials: K
authors.lastname: Kaserer
authors.forename: Bruno
authors.initials: B
authors.lastname: Niederle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002116:Calcitonin / Q000187:drug effects*; D018276:Carcinoma, Medullary / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005765:Gastrointestinal Agents; D006801:Humans; D007432:Intraoperative Period; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010418:Pentagastrin; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000601:surgery; D013965:Thyroidectomy
chemical_list: D005765:Gastrointestinal Agents; D002116:Calcitonin; D010418:Pentagastrin