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This Article Accepted manuscript (PDF) All Versions of this Article: ERC-08-0152v1 16/1/225    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Faggiano, A. Articles by Ferolla, P. Search for Related Content PubMed PubMed Citation Articles by Faggiano, A. Articles by Ferolla, P.

A Faggiano, Molecular and Clinical Endocrinology and Oncology, Federico II University, Napoli, 80131, Italy
F Grimaldi, Endocrinology, "S. Maria della Misericordia" Hospital, Napoli, Italy
L Pezzullo, Surgery, National Cancer Institute, "Fondazione G. Pascale", Napoli, Italy
M Grazia Chiofalo, Surgery, National Cancer Institute, "Fondazione G. Pascale", Napoli, Italy
C Caraco, Nuclear Medicine, National Cancer Institute, "Fondazione G. Pascale", Napoli, Italy
N Mozzillo, Surgery, National Cancer Institute, "Fondazione G. Pascale", Naples, Italy
G Angeletti, IMISEM, University of Perugia, Perugia, Italy
F Santeusanio, IMISEM, University of Perugia, Perugia, Italy
G Lombardi, Molecolar and Clinical Endocrinology and Oncology, Federico II University, Napoli, Italy
A Colao, Molecular and Clinical Endocrinology and Oncology, Federico II University, Napoli, Italy
N Avenia, Endocrine Surgery, University of Perugia, Napoli, Italy
P Ferolla, IMISEM, University of Perugia, Perugia, Italy

Correspondence: Antongiulio Faggiano, Email: afaggian{at}unina.it

Abstract

Background and Objective: In patients with postoperative persistent medullary thyroid cancer (MTC), the tumor detection rate is generally low for most of the imaging techniques now available. The aim of this study was to investigate if the the clinico-biological profile of the tumor may indicate which imaging technique to perform in order to identify postoperative persistent or relapsing MTC foci.

Patients and Methods: Thirty-five consecutive MTC patients with detectable and progressively increasing postoperative serum concentrations of calcitonin were enrolled in the study. The detection rates of 18F-deoxy-D-glucose (FDG)-positron emission tomography (PET), somatostatin receptor scintigraphy (SRS) and 131I-metaiodobenzylguanidine scintigraphy (MIBG) were compared in relation with calcitonin and carcinoembryonic antigen serum concentrations, Ki-67 score and results of conventional imaging techniques (CIT).

Results: FDG-PET positivity was significantly associated with calcitonin serum concentrations >400 pg/ml and Ki-67 score >2.0% (p<0.05), while SRS positivity was associated with calcitonin serum concentrations >800 pg/ml (p<0.05). SRS positivity significantly correlated with tumor appearance at CIT (p<0.01), while FDG-PET was positive in 9 CIT-negative patients.

Conclusion: The secretive and proliferative tumor profile may guide the choice of the imaging technique to use in the follow-up of patients with MTC. A Ki-67 score >2.0% suggests to perform a FDG-PET in addition to conventional imaging. Calcitonin secretion predicts both FDG-PET and SRS uptake but SRS positivity is generally found only in patients with well defined MTC lesions which are also detectable at the conventional imaging examination. MIBG outcome is not predicted by any clinico-biological factors here investigated.