The value of intraoperative pentagastrin testing in medullary thyroid cancer.
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.
Scheuba
Christian
C
Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria. christian.scheuba@meduniwien.ac.at
Bieglmayer
Christian
C
Asari
Reza
R
Kaczirek
Klaus
K
Izay
Barbara
B
Kaserer
Klaus
K
Niederle
Bruno
B
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
D005765:Gastrointestinal Agents; D002116:Calcitonin; D010418:Pentagastrin