Presentation of points of general discussion and voting among the speakers of the European Thyroid Association-Cancer Research Network (ETA-CRN) meeting in Lisbon, 2009, entitled ”European comments to ATA medullary thyroid cancer guidelines”

The main subjects of discussion, held online within the ETA-CRN board invited 16 expert-panelists are shown. The ad hoc emerged ETA-CRN panel of experts (EPE) first congratulated Professor Kloos and the ATA Taskforce for the extensive work on medullary thyroid cancer, and appreciated discussing the ATA guidelines during the ETA-CRN meeting. As it was not possible for all experts to visit the meeting, they enclosed their comments in the online ETA forum. The overall intention was to evaluate certain discrepancies between the ATA guidelines and were biased European clinical practice.All discussants were aware that the ATA guidelines had followed evidence based medicine rules; however, it was intended to reach an European consensus in this matter. The results of online voting among the EPE are shown.We received answers from nine experts. The particular ATA guidelines devoted to the management of MTC ranged in agreement in 0/9 to 4/9. This did not reflect the general, good assessment of the guidelines, as of votes a set of questions.The strongest discrepancies were found in assessment of the usefulness of pentagastrin (Peptavlon®) stimulated calcitonin secretion. The majority of the EPE (5/9) chose an option: "the increase of the basal Ct >100 ng/L means the substantial risk of MTC. However, there should also have been a recommendation for the grey zone 10-100 ng/L, where stimulation with pentagastrin is useful. The cut-off to perform stimulation test at ≤ 15-20 ng/L and values >100 ng/L means a significant suspicion of MTC".Similarly, attention from the EPE was raised towards the surgical procedures in MTC, particularly the extent and indications for lymph node surgical intervention. Four questions were related to the indications to lymphadenectomy and extent of surgery. The equal number (4/8) of EPE agreed with the ATA R61 and half of the ETA-CRN panel of experts disagreed because the indications to lymphadenectomy (Lx) depended in their opinion on the tumors detected by the Ct screening, in which prophylactic Lx might not be necessary."Notwithstanding the evidence based guidelines, their final acceptation requires unrestricted discussion and consideration of differences in clinical practice and experience between countries".