SELECTIVE VENOUS SAMPLING CATHETERIZATION FOR LOCALIZATION OF PERSISTING MEDULLARY-THYROID CARCINOMA

Selective venous sampling catheterisation was performed in 19 patients with medullary thyroid carcinoma without known distant metastases for persistent hypercalcitoninaemia after surgery. Calcitonin (CT) gradie nts were found in the neck and/or the mediastinum in 18 patients and i n five patients at distant sites also. After Venous catheterisation, 1 3 patients were subjected to repeat surgery. Neck and/or mediastinal t umour foci were found in 12 patients at the sites of the CT gradients. Of these, nine patients had only cervicamediastinal CT gradients: aft er reoperation, the serum CT level normalised in one, significantly de creased in five, and did not change in three, and no neck relapse occu rred after a mean follow-up of 5.3 years. Distant metastases emerged c linically in all five patients with distant gradients and in only one of the 14 patients with no distant gradient. In conclusion, selective venous catheterisation is the most sensitive tool for the localisation of residual disease and for the early detection of distant metastases . However, in patients with only local disease, biochemical cure is ra rely obtained after reoperation.