title: Intraoperative high-dose calcium stimulation test in patients with sporadic medullary thyroid carcinoma is highly accurate in predicting lateral neck metastases.
abstract: BACKGROUND
  Intraoperative measurement of calcitonin is not highly accurate in predicting the completeness of the operative resection after total thyroidectomy combined with central neck dissection (TT-CND) in patients with medullary thyroid carcinoma (MTC). We evaluated whether an intraoperative, high-dose calcium stimulation test (IO-CST) after TT-CND can predict lateral neck involvement.
  
  
  METHODS
  Eleven patients who underwent primary operation for sporadic MTC were included. High-dose (25 mg/kg) calcium gluconate was administered after TT-CND with calcitonin measured at 2, 5, and 10 minutes after the calcium gluconate infusion.
  
  
  RESULTS
  There were 2 males and 9 females (mean age, 51 years; range, 18-88). Three patients showed lateral neck metastases. At a mean follow-up of 7.0 months (range, 2-10), 1 patient showed distant metastases and 1 a slightly increased calcitonin level. After IO-CST, serum calcitonin increased in all the 3 patients with lateral neck metastases, and it remained unchanged or decreased in the other patients without lateral neck metastases. Percent variation of serum calcitonin after IO-CST was 92% in patients with lateral neck metastases and -3.1 ± 4.9% in patients without lateral neck metastases.
  
  
  CONCLUSIONS
  Calcitonin measurement after IO-CST in patients with sporadic MTC can be highly accurate in predicting lateral neck nodes involvement. These results could represent a stimulus toward the development of a quick calcitonin assay.
authors.affiliation: U.O. Chirurgia Endocrina e Metabolica, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: De Crea
authors.affiliation: U.O. Chirurgia Endocrina e Metabolica, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: marcoraffaelli@rm.unicatt.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Raffaelli
authors.affiliation: U.O. Chirurgia Endocrina e Metabolica, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Milano
authors.affiliation: U.O. Analisi Ormonali e Biologia Molecolare Clinica, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Carrozza
authors.affiliation: U.O. Analisi Ormonali e Biologia Molecolare Clinica, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Zuppi
authors.affiliation: U.O. Chirurgia Endocrina e Metabolica, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Bellantone
authors.affiliation: U.O. Chirurgia Endocrina e Metabolica, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Celestino Pio
authors.initials: CP
authors.lastname: Lombardi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002116:Calcitonin / Q000097:blood* / Q000378:metabolism; D002118:Calcium / Q000008:administration & dosage*; D018278:Carcinoma, Neuroendocrine / Q000097:blood / Q000378:metabolism / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009333:Neck; D037981:Neck Dissection; D013964:Thyroid Neoplasms / Q000097:blood / Q000378:metabolism / Q000601:surgery*; D013965:Thyroidectomy; D055815:Young Adult
chemical_list: D002116:Calcitonin; D002118:Calcium