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PubMedDate not supplied

[Papillary microcarcinoma [correction of carcinoma] of the thyroid: clinical experience and prognosis factors].

Thyroid neoplasm of less than 10 mm in the largest diameter are defined as minimal thyroid cancer (MTC). These tumors are a common incidental finding at autopsy and in thyroid glands excised for other pathology. These tumors can metastasize and can cause significant morbidity and mortality. Clinical significance and optimal operative procedures of these lesions are still questioned. We studied 35 MTC in order to identify clinical and histologic characteristics as prognostic factors and to establish therapeutic management strategies. From January 1988 to December 1998, 177 patients with a primary thyroid cancer underwent surgery in the Department of endocrine-surgery of Catholic University in Rome: 35 of them (19.7%) had a MTC. In the post-operative follow-up 13 of the patients with MTC had a lymph node recurrency and/or distant metastases. Careful histologic examination showed multifocality in 12 patients, capsular infiltration in 10 patients and a solid tumor in 9 patients. MTC are common and they are associated with a good prognosis. Our multifactorial analysis has identified as important risk factors: capsular infiltration, solid lesion and multifocal disease. In these cases total thyroidectomy is mandatory.

Adult↗
PubMed2000

[Detection of remnants after removal of medullary thyroid carcinoma].

OBJECTIVE: To assess whether calcium stimulation test or somatostain-receptor (SS-R) imaging could early detect remnants after removal of medullary thyroid carcinoma (MTC). METHODS: Calcitonin stimulation (calcium element 3 mg/kg weight, i.v. 10 min), carcino-embryonic antigen (CEA), gastrin (GST) and vasoactive intestinal peptide (VIP) were tested in 14 patients with postoperative MTC. SS-R imaging was used to localize the remnants after removal of MTC in patients with elevated calcitonin. RESULTS: Calcitonin stimulation test showed that the peak value of serum calcitonin was elevated in all patients, of whom 7 had the elevated vatue of basic calcitonin and peak calcitonin. In the 7 patients, SS-R imaging showed normal CEA, GST and VIP. CONCLUSIONS: It is necessary for patients after removal of MTC to perform calcitonin stimulation test for detecting remnants early. SS-R imaging may be useful for localizing remnants and metastatic foci. CEA, GST and VIP are not significant in monitoring MTC after operation.

Adult↗
PubMed2001

[Preliminary study on CTL enhancement induced by IL-4 gene modified HL-60 cells].

OBJECTIVE: To explore the mechanism of enhancing killing activity of tumor cell-specific cytotoxic T lymphocyte (CTL) by IL-4 gene modified tumor cells (IL-4mTC). METHODS: IL-4 gene was introduced into HL-60 cells through retroviral vector PL-IL-4-SN. Wild and IL-4 mTC were used to induce CTL responses, and cell surface molecules were assayed by flow cytometry. RESULTS: The killing activity of tumor cell-specific CTL in IL-4 mTC group was increased from 11.8% to 77.2%, about sevenfold higher than that induced by wild HL-60 cells (P < 0.01). High level expression of MHC class II antigens as well as B7-1 and ICAM-1 molecules was observed in IL-4 mTC. The expression of MHC class I antigen was not affected by IL-4 gene modification. The expression of cell surface molecules induced by IL-4 mTC was completely abrogated by anti-IL-4 McAb. A significant increase of IL-2 secretions was detected during IL-4 mTC inducing CTL responses. IL-2 secretion and CTL response were inhibited by anti-IL-4 or anti-surface molecule McAbs. CONCLUSION: IL-4 gene modification might enhance the tumor cell-specific CTL killing activities by inducing cell surface molecules expression and IL-2 secretion.

Cytotoxicity, Immunologic↗
PubMed2001

[Proto-oncogene RET somatic mutations in medullary thyroid carcinoma].

UNLABELLED: Somatic mutations of the RET protooncogene are present in 23-68% cases of sporadic medullary thyroid carcinoma (MTC). The aim of the study was to introduce the RET somatic mutations analysis in tumor tissue as well as to evaluate their types and frequencies in postoperative specimens of MTC patients treated in the Center of Oncology in Gliwice. MATERIAL: 14 tumor tissues obtained from sporadic MTC patients and two control groups--six and four specimens from patients with MEN 2A and MEN 2B syndrome respectively. METHODS: Tumor tissue DNA isolation followed by PCR amplification of RET exons 10, 11, 13, 14, 16 and automated, fluorescent sequencing of PCR products. We identified somatic mutation ATG > ACG in codon 918, exon 16 in 7 of 14 (50%) of analyzed sporadic MTC cases. We also found one deletion/insertion mutation in RET exon 11 that encompasses cysteine codon 634 and has not been published so far. The types and frequencies of found RET gene mutations were similar to previously reported. The analysis of RET somatic mutations supports the differentiation between the sporadic and inherited MTC. The presence of somatic mutation and its simultaneous absence in the germline proves sporadic type of cancer.

Carcinoma, Medullary↗
PubMed2003

Factors affecting long-term survival of Taiwanese patients with medullary thyroid carcinoma.

BACKGROUND AND PURPOSE: Long-term survival of patients with postoperative recurrence of medullary thyroid carcinoma (MTC) is not uncommon. This study assessed whether local or distant recurrence after operation is a significant factor affecting long-term survival in Taiwanese patients with MTC. The benefit of family screening for MTC patients on survival was also evaluated. METHODS: A total of 54 patients with a diagnosis of MTC by pathology or cytology during the period from 1977 to 2000 were included in the study. Survival curves were compared between different groups according to age, gender, tumor size, metastasis, recurrence after surgical intervention, or diagnosis before and after the performance of family screening for MTC patients. RESULTS: The 5-year survival rate using the Kaplan-Meier method was 84.1% (95% confidence interval, 73.9% to 94.2%), and the 10-year survival rate was 77.6% (95% confidence interval, 64.9% to 90.3%). Patients with lymph node metastasis and distant metastasis before operation had significantly shorter survival. Surprisingly, recurrence was not associated with shorter survival. Patients diagnosed after the start of family screening in 1991 had fewer lymph node metastases before operation, and lived longer. CONCLUSIONS: Patients with lymph node or distant metastasis before operation had poor prognosis. However, local or distant recurrence after operation did not influence survival. Efforts to obtain early diagnosis and surgical intervention before tumor metastasis, such as family screening, resulted in improved survival.

Adolescent↗
PubMed2003

Medullary thyroid carcinoma and hormones.

Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor. The identification of calcitonin as a specific and sensitive marker in 1968 determined a special interest of endocrinologists. Many hormones have been isolated in MTC tumors. Calcitonin, prostaglandins and somatostatin are of particular interest. Calcitonin is not only a marker, but is indicative of tumor size and prognosis. Moreover the presence of calcitonin receptors in MTC could have a role in the proliferation of this tumor. Somatostatin and the large use of somatostatin analogs in the treatment of neuroendocrine tumors raise the hope that these drugs could be effective in MTC patients. Unfortunately, the benefits of these treatments is not validated. More interestingly, nonsteroidal anti-inflammatory drugs could be of interest in this tumor by comparison of their use in colorectal polyps. By inhibiting Cox or inducing 15 PGDH enzymes, we have demonstrated in vitro its effectiveness. Thus, hormones in MTC are not only markers but probably mediate biological effects involved in tumor growth.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1992

Long-term follow-up of a large North American kindred with multiple endocrine neoplasia type 2A.

BACKGROUND: Sixty-one patients with multiple endocrine neoplasia (MEN) type 2A (27 men; 34 women; mean age, 39 years) from a single kindred (76 affected, 49 at risk) were followed 1 month to 33 years (median, 14 years) after diagnosis for disease expression. METHODS: Peripheral basal and pentagastrin-stimulated calcitonin, parathyroid hormone, and calcium levels were measured in 60 patients, 58 of whom had undergone previous thyroidectomy; the calcitonin concentration in four patients was concomitantly determined in the hepatic and internal jugular veins. Biochemical or radiographic screening for pheochromocytoma was performed in 58 patients. RESULTS: Recurrence of medullary thyroid carcinoma (MTC) developed in nineteen (33%) of 58 patients after they underwent thyroidectomies. In 14 of 19 patients regional metastases were inapparent at initial operation, and lymphadenectomy was not undertaken. Three patients underwent neck reexploration with removal of micrometastases after selective venous studies were performed. One patient, 33 years of age, died of MTC, and two patients who refused thyroidectomy are alive at 76 and 83 years of age. Fifteen patients are alive with disease 8 to 33 years after they underwent thyroidectomies. All patients identified by prospective screening remain pentagastrin negative. Pheochromocytoma developed in six patients (10%), and four patients have Hirschsprung's disease. Hyperparathyroidism was present in seven patients and did not occur in those with minimal MTC. CONCLUSIONS: These observations suggest that (1) the course of MTC in MEN 2A is highly variable, (2) early treatment of C-cell disease can be curative, (3) routine lymphadenectomy for occult micrometastases may be necessary for cure of MTC, and (4) the hyperparathyroidism of MEN 2A may not be a primary genetic event.

Adolescent↗
PubMed2004

Detection of corticospinal tract compromise in amyotrophic lateral sclerosis with brain MR imaging: relevance of the T1-weighted spin-echo magnetization transfer contrast sequence.

BACKGROUND AND PURPOSE: Hyperintensity in the posterior limb of the internal capsule at T2-weighted MR imaging, consistent with corticospinal tract (CST) degeneration, is described in amyotrophic lateral sclerosis (ALS). However, the lack of specific tests or biological markers hinders confirmation of the diagnosis, especially in the early stages. We investigated the CST in ALS with MR imaging. METHODS: We examined 25 patients (14 men, 11 women; mean age, 49.1 years; range, 29-68 years) and 21 age- and sex-matched control subjects without upper motor neuron signs. According to the revised El Escorial criteria, 22 patients had definite ALS; two, probable ALS; and one, suspected ALS. Fluid-attenuated inversion recovery (FLAIR; TR/TE/TI, 11,000/140/2600) and T1-weighted spin-echo (SE)/magnetization transfer contrast-enhanced (MTC; TR/TE, 510/12) imaging was performed at 1 T. Two experienced neuroradiologists blinded to the patients' history independently evaluated the CST. RESULTS: T1-weighted SE MTC imaging allowed visualization of the CST in both patients and control subjects. T1-weighted SE MTC images showed hypointensity along the CST and bilateral subcortical regions of the precentral gyri in all control subjects and hyperintensity in 80% of patients with ALS (P < .05). FLAIR images showed hyperintensity in these areas in both groups, with no significant difference. CONCLUSION: T1-weighted SE MTC imaging is sensitive and accurate in depicting CST lesions in ALS, whereas FLAIR imaging is not. T1-weighted SE MTC imaging is useful in diagnosing ALS by showing hyperintense areas along the CST, which separates patients from control subjects. This sequence should be included in the workup of patients with weakness and pyramidal signs.

Adult↗
PubMed2005

Evaluation of a rapid differentiation test for the Mycobacterium tuberculosis complex by selective inhibition with rho-nitrobenzoic acid and thiophene-2-carboxylic acid hydrazide.

SETTING: Mycobacterial growth in media to which inhibitory substances are added has been used in species identification. Growth of the Mycobacterium tuberculosis complex (MTC) is inhibited by rho-nitrobenzoic acid (PNB), whereas non-tuberculous mycobacteria (NTM) are resistant. Thiophene-2-carboxylic acid hydrazide (TCH) is useful in the differentiation of MTC when performed together with other tests. OBJECTIVE: To develop a test using PNB or TCH added to culture medium, and to evaluate its usefulness in the screening of mycobacteria isolates. DESIGN: In 2001, PNB testing was performed in 109 M. tuberculosis strains identified by Instituto Adolfo Lutz (IAL) and 52 NTM strains from the institute's culture collection. The drugs were added to Löwenstein-Jensen (LJ) medium and to BBL-MGIT. RESULTS: Species differentiation of MTC with the MGIT/TCH method was similar to that observed using the conventional LJ/TCH method. The accuracy of the MGIT/PNB method to differentiate NTM and MTC strains was 99.4%. The BBL-MGIT system allowed presumptive identification in 3-11 days, compared to > or =12 days with LJ medium. CONCLUSION: A simple, low-cost test using growth inhibitors may be incorporated into a modern, safe and quick methodology enabling differentiation of MTC and NTM.

Bacteriological Techniques↗
PubMed2005

Medullary thyroid carcinoma in a child with a new RET mutation and a RET polymorphism.

We report a 12 year old boy with an isolated medullary thyroid carcinoma (MTC). A mutation analysis of the RET-proto-oncogene in this boy showed an in frame insertion-deletion mutation (insTTCTdelG) at codon 666 of the RET proto-oncogene. This RET mutation has not been reported previously. The boy's mother and his 82-year-old maternal grandfather showed the same mutation. None of the two ever showed symptoms of MTC. The mother underwent a preventive total thyroidectomy and pathological examination showed C-cell hyperplasia and early MTC. Further genetic analysis showed that the boy inherited a well-known coding polymorphism in exon 11 (G691S) from his father. Therefore the boy is a compound heterozygote for the insertion-deletion mutation at codon 666 and the G691S polymorphism in the RET gene. We hypothesize that the insTTCTdelG mutation at codon 666 is associated with low penetrance for MTC and that the young age of MTC in the reported child results most likely from the additive effects of both mutations (insTTCTdelG and G691S).

Carcinoma, Medullary↗
PubMed2006

Giant meta-typical carcinoma: an unusual tumor.

Meta-typical carcinoma (MTC) or basosquamous carcinoma is a remarkable malignancy with features of both basal and squamous cell carcinoma. It is typically located on the back and face, often with clinical features of basal cell carcinoma but tending to be more aggressive with enhanced prospects of lymph node or distant metastases. Our report describes a huge neglected MTC of the back of ten-year duration, a giant ulcero-vegetative tumor measuring 20 x 25 cm. Histologic examination of specimens from the margins and periphery revealed aspects of both basal and squamous cell carcinoma, while the ulcerated center showed sclerotic tissue without tumor. Radical excision and reconstruction by grafts were performed. No metastases were observed after two years. There are many controversies surrounding the histologic definition and biologic behavior of MTC, including its metastasizing potential. The MTC we describe exhibited benign biologic behavior. This may have been related to an intense inflammatory host response with elimination of neoplastic tissue and consequent local sclerosis evident in the central tumor-free portion. This central tumor regression is to our knowledge a unique finding in MTC.

Aged↗
PubMed1991

Early thyroidectomy for medullary thyroid carcinoma in children and young adults with the multiple endocrine neoplasia type 2A (MEN 2A) syndrome.

A South African family, at risk for the multiple endocrine neoplasia type 2A (MEN 2A) syndrome, was identified. The Bloemfontein MEN Study Group was founded, inter alia, to study the effects of early detection of medullary carcinoma of the thyroid (MTC) and treatment by total thyroidectomy in children and young adults with MEN 2A. Genotypes were identified by DNA probe and MTC diagnosed by basal and stimulated calcitonin levels. Between 1986 and 1989, 10 members of the family underwent total thyroidectomy and central lymph node dissection for MTC. There were 6 female and 4 male patients (mean age 22,0 years; range 10 - 35 years). Histological examination of the resected thyroid revealed MTC in all patients; 8 had bilateral disease and 2 unilateral. Lymph nodes were negative for MTC in all patients. None of the patients suffered injury to the recurrent nerve, while 1 experienced transient hypoparathyroidism postoperatively. Replacement therapy is maintaining thyroid hormone levels in all patients. Screening should probably begin at the age of 1 year, and total thyroidectomy should be performed when an elevated calcitonin level is observed.

Adolescent↗
PubMed2006

[Analysis of chromosome deletions of TbDl, RD6 and pks15/1 in clinical strains of Mycobacterium tuberculosis].

Deletions are very important sources of the variability among members of the mycobacterial tuberculosis complex (MTC). Deletion analysis of MTC clinical isolates was performed to clarify phylogenetic relationships and help to identify epidemiologically significant groups of the MTC. In this study, the variability of the TbDl, RD6 and pks15/1 chromosome loci in clinical MTC strains and comparison of those results with IS6110-RFLP (restriction fragment length polymorphism), sSNP (synonymous single nucleotide polymorphism), PGG (Principal Genetic Group) typing data were used to determine if these chromosome regions constitute good molecular markers for some of the epidemiologically important groups of the MTC. In the present study, 122, 61 and 294 clinical isolates were tested for the TbDl, RD6 and pks15/1 deletions, respectively. Specific probes were designed and used in RFLP analysis as well as sequencing techniques were applied. We found that all strains with intact TbDl region belonged to the sSNP cluster I, PGG 1 (katG463Leu and gyrA95Thr). The RD6 deletion was not determined to be a strict characteristic feature of any specific genetic group of the tested M.tb strains, but presence of this deletion is presumed for strains of high virulence, and associated with principal genetic groups 2 or 3. The genetic event that led to this deletion likely occurred in the strain that belongs to PGG 1. Identification of strains with an intact pksl5/1 gene cluster provided a potential marker for virulence. An intact pks15/1 gene cluster is required for the biosynthesis of the phenolic glycolipids (PGL-tb), production of which by clinical isolates was correlated with virulence.

Bacterial Proteins↗
PubMedDate not supplied

[The use of a new analogue DGlu-Octagastrin in scintigraphy of medullary thyroid carcinoma].

INTRODUCTION: Medullary thyroid carcinomas (MTC) reveal overexpression of several peptide receptors particularly of gastrin and cholecystokinin 2 (CCK2). Experimental studies of various CCK-2/gastrin analogues found that a C-terminal, 8-aminoacid peptide, (D)Glu-octagastrin, has optimal properties. Thus, the aim of our studies was to prepare (99m)Tc-labelled HYNIC-octagastrin, to evaluate its biologic tolerance in animals and introduce for scintigraphy in patients with MTC. MATERIAL AND METHODS: HYNIC-(D)Glu-octagastrin was from piCHEM (Graz, Austria), (99m)Tc generator from Amersham (Health), other reagents were purchased from Sigma. Labelling of the peptide was performed in phosphate buffer of pH 6.0 for 10 minutes at 100(o)C using EDDA and tricine as coligands. RESULTS: The labeling yields were high (above 95%); the specific activity amounted to 1200 to 1430 microCi/microg. Radiochemical purity on SepPak cartridge and ITLC ranged from 94 to 98%. No adverse effects were observed in mice after administration of 10 to 50 times greater doses that those used in patients. Clinical studies comprised 20 patients with MTC and high serum calcitonin. (99m)Tc-EDDA/HYNIC-(D)Glu-octagastrin, 500 to 700 MBq, was administered iv and whole body scintigraphy was performed using a double head gamma-camera (Varicam, Elscint) 2 and 4 hours later. Increased accumulation of the tracer in foci of MTC and its metastases was found in 8 patients. CONCLUSIONS: Scintigraphy with a new gastrin analogue ((D)Glu-octagastrin) makes it possible to detect MTC with overexpression of CCK-2/gastrin receptors and to select patients for receptor-mediated radiopeptide therapy using DOTA-gastrin analogues labelled with (177)Lu and (90)Y.

Animals↗
PubMedDate not supplied

[The role of scintigraphy with the use of 99mTc-HYNIC-TOC in the diagnosis of medullary thyroid carcinoma].

INTRODUCTION: Recently a new somatostatin analogue labelled with (99m)Tc ((99m)Tc-HYNIC-TOC) has been synthetized. Aim of this study was to evaluate the utility of (99m)Tc-HYNIC-TOC in the radionuclide imaging in patients with medullary thyroid carcinoma (MTC). MATERIAL AND METHODS: 30 patients with MTC aged 22-83 years in different stages of the disease were investigated. In 6 patients (group 1) scintigraphy was performed before surgery directly after diagnosis of MTC. Four patients (group 2) were qualified to the study in the phase of remission after surgical treatment that had been confirmed by low concentrations of calcitonin. Twenty patients (group 3) were investigated due to stagnation or recurrence confirmed by persistent hypercalcitoninemia. The scintigraphy using (99m)Tc-HYNIC-TOC (Tektrotyd, POLATOM) was performed 2 and 4 hours post injection of 20 mCi (740 MBq) of the tracer. Other imaging techniques were also employed and analysed in individual cases (US, CT, (99m)Tc(V)-DMSA, (131)I-MIBG, (99m)Tc-MDP, (111)In-octreotide and FDG-PET). RESULTS: Images obtained 2 and 4 hours p.i. were similar. In group 1, uptake of the tracer was found in the primary tumour of MTC in all patients. In group 2, a false positive result was found in 1 of 6 patients. In the remaining 5 of 6 cases no pathological foci were visualised. In group 3, uptake in the thyroid bed was found in 3 of 20 cases and in the lymph nodes in 14 of 20 patients. In 3 of 20 cases uptake in the bone metastases was found. Globally, sensitivity of the scintigraphy using (99m)Tc-HYNIC-TOC was 86.4%, specificity - 75.0%, and accuracy - 84.6%. CONCLUSION: The scintigraphy using (99m)Tc-HYNIC-TOC showed high utility in the diagnosis of MTC. Confirmation of the presence of somatostatin receptors with this method may be used for treatment planning: surgery or radionuclide therapy.

Adult↗
PubMedDate not supplied

Positron emission tomography (18FDG-PET) in the detection of medullary thyroid carcinoma metastases.

INTRODUCTION: Medullary thyroid carcinoma (MTC) is usually more advanced at presentation than differentiated thyroid cancers and often has distant metastases. The primary treatment of MTC is total thyroidectomy and regional lymph node dissection. The efficacy of these procedures has been limited by the aggressiveness of the disease and metastatic spread at the time of surgery. Persistently elevated levels of calcitonin (CT) and carcinoembryonic antigen (CEA) or their increase postoperatively are indicative for residual or recurrent disease. Conventional imaging methods such as ultrasonography, computed tomography, magnetic resonance imaging and MIBI scintigraphy usually fail to find the source of calcitonin. Better imaging properties have been shown by DMSA scintigraphy, somatostatin receptor scintigraphy or by positron emission tomography (PET). The aim of the study was to evaluate the diagnostic accuracy of PET for the localisation of occult MTC in patients after surgery with increased concentrations of CT, in whom conventional imaging procedures have not been successful. MATERIAL AND METHODS: The PET investigation using (18)F-fluoro- 2-deoxy-D-glucose combined with computed tomography ((18)FDG-PET/CT) was performed at the Department of Nuclear Medicine (Oncology Centre in Bydgoszcz) between January and October 2004. In five patients with postoperative calcitonin ranging from 164 to > 2000 ng/l (normal < 10 ng/l) no tumour lesions were found using other imaging methods. RESULTS: In four of five cases, responsible lesions with a higher metabolism of FDG, indicating MTC tissue (remnants or metastases), were localised. In one patient no focus of FDG accumulation was found despite high CT concentration. PET detected tumour manifestations in the neck and the mediastinum in two patients, in the lung and the left adrenal gland in one case and in the neck and the liver in another patient. As a result of surgery for the removal of a residual tumour or metastases the accuracy of diagnosis was confirmed by histopathology in all four cases and a decrease in CT and CEA levels was observed in 3/4 cases. The metabolic imaging findings by PET/CT ensured that the surgery on these patients was successful. CONCLUSIONS: For the detection of occult residual or metastatic MTC lesions, (18)FDG-PET is a valuable procedure in imaging diagnostics.

Adult↗
PubMed1991

[Experimental studies on tissue injury by microwave tissue coagulator].

The tissue injury caused by Microwave Tissue Coagulator (MTC) was assessed clinically and experimentally with dogs. Following hepatic transection using MTC on condition that the output was 60 watts and radiation lasted for 60 seconds at one time, GOT, GPT, lactic acid, FDP and endotoxin concentration increased and coagulation parameters such as hepaplastin test were deteriorated transiently. Of tissue injury, following results were obtained. 1) The mechanism of tissue injury by MTC consists of direct heat injury and infarct by circulatory disturbance. The extent of injury from the needle electrode is approximately 10 mm in the former mechanism and 20mm in the latter. 2) Injury of vessels in Glisson's sheath was confirmed up to 50mm apart from the needle electrode by labelling index of bromodeoxyuridine in bile duct epithelial cells. 3) The granulation formation at the site of necrosis was considerably retarded by wound infection. Accordingly, when MTC is utilized on hepatectomy, followings should be noted: 1) To prevent the large intrahepatic vessels from heat injury, MTC may be utilized at the surface of the liver and the needle electrode must be punctured more than 10mm apart from them. 2) Bile leakage at the resected stump should be eliminated to prevent infection at the stump.

Animals↗
PubMedDate not supplied

Role of [131I]metaiodobenzylguanidine therapy in medullary thyroid carcinoma.

In recent years several radiopharmaceuticals have become available, offering new possibilities for the diagnosis and therapy of medullary thyroid carcinoma (MTC). For the diagnosis and follow-up 201TI-chloride and 99mTc(V)-DMSA are the tracers of choice. Imaging with [131I]metaiodobenzylguanidine (131I-MIBG) and 131I-anti-CEA or anti-calcitonin antibodies or fragments is less sensitive but very specific. These tracers can be used to evaluate their potential therapeutic use. Cumulative reported data on the diagnostic use of 131I-MIBG in 178 MTC patients indicate that overall 34.5% of medullary cancers concentrate MIBG. At The Netherlands Cancer Institute 131I-MIBG scintigraphy was positive in 8 of 23 patients with MTC. Four of these patients have received therapeutic amounts of 131I-MIBG, resulting in 1 partial remission and meaningful palliation in 3 patients with metastatic MTC. It is concluded that, although the preliminary experience suggests that the objective response of MTC to 131I-MIBG therapy is limited, the palliation provided to these patients, for whom there is little other treatment, may be very meaningful.

3-Iodobenzylguanidine↗