Calcitonin Measurement to Detect Medullary Thyroid Carcinoma in Nodular Goiter: German Evidence-Based Consensus Recommendation

Context: Serum calcitonin (hCT) measurement may be useful for detecting medullary thyroid carcinoma (MTC), but the routine use of hCT after pentagastrin stimulation to screen patients with nodular thyroid disease remains controversial. Patients: A total of 1007 patients (567 females and 440 males) with nodular thyroid disease and a mean age of 55G14 (meanGS.D.) years were included in the study. All patients did not have impaired renal function, bacterial infection, alcohol and drug abuse, pseudohypoparathyroidism, or protonpump inhibitor therapy. Individuals referred with known elevation of hCT, Graves' disease, or autoimmune thyroid disease were not considered or included in this investigation. Methods: Serum hCT levels were determined under basal conditions, and when basal values were R10 and !100 pg/ml, testing was repeated after pentagastrin stimulation. Patients with basal or stimulated levels O100 pg/ml were referred for surgery. Results: hCT levels O10 pg/ml were increased in 17 patients (1.7%). One patient had a basal hCT level of 4400 pg/ml with a histological confirmation of a MTC. In this patient, pentagastrin test was not performed. Sixteen patients with basal hCT between 10 and 100 pg/ml underwent pentagastrinstimulated hCT measurement. Of 16 patients, 4 had stimulated hCTO100 pg/ml. Of 17 patients with hCTO10 pg/ml, 2 had MTC, and of 17 patients, 3 had C-cell hyperplasia. In total, two patients (0.20%) had a histologically verified MTC. Conclusions: Basal hCT measurement together with pentagastrin-stimulated hCT measurement in cases of basal hCTO10 pg/ml detects MTC in 0.20% of patients with nodular thyroid disease. Whether this high incidence of MTC has major implications or not has to be discussed, but it should be considered as a useful and recommended tool for early detection of MTC and to save patients' life.

Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Calcitonin screening and pentagastrin testing: predictive value for the diagnosis of medullary carcinoma in nodular thyroid disease

Herrmann¹,

Schmid²,

Goerges³

et al. 2010

“…The reasons underlying these disparate trends are unknown. In Europe, calcitonin screening of patients with thyroid nodules has been embraced with greater enthusiasm (30,31) than in the US, where it is not routinely recommended because of concerns regarding its cost-effectiveness (33,34).…”

Section: Trends Of Primary Tumor Size In Patients With Papillary and mentioning

confidence: 99%

Decreasing tumor size of thyroid cancer in Germany: institutional experience 1995–2009

Machens

Dralle²

2010

Objective: Decreasing tumor size in a population over time is widely interpreted as a measure of effectiveness of cancer screening programs. Nonetheless, thyroid cancer size is rarely analyzed as a function of time. This study aimed to explore secular trends of thyroid cancer diameter in Germany. Design: Retrospective analysis of 1644 thyroid cancer patients from a large referral center for thyroid cancer (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009). Methods: Calculation of largest tumor diameters for each type of cancer as a function of time periods and birth cohorts. Results: Over the past 25 years, subdivided into 5-year periods by year of thyroidectomy

“…This prompted the German Society for Endocrinology Thyroid Group in 2004 (11), followed by an interdisciplinary European consensus group in 2006 (12), to recommend calcitonin screening in patients with nodular thyroid disease. These recommendations have been greeted with less enthusiasm in some parts of the world because of lingering concerns regarding cost-effectiveness, prompting the revised American Thyroid Association guidelines to recommend neither for nor against the routine use of calcitonin screening in patients with nodular goiters (13).…”

Section: Introductionmentioning

confidence: 99%

Surgical cure rates of sporadic medullary thyroid cancer in the era of calcitonin screening

Machens

Dralle

2016

Objective: Time trends of the extent of disease at first diagnosis and biochemical cure remain ill-defined for sporadic medullary thyroid cancer (MTC). This investigation aimed to delineate time trends and biochemical cure rates for sporadic MTC. Design: This was an observational study of consecutive patients operated on for sporadic MTC between 1995 and 2015. Methods: Time trends of clinical and histopathological variables indicative of the extent of disease and biochemical cure were calculated for 600 patients with sporadic MTC, 322 of whom had initial neck surgery and 278 of whom had neck reoperation at a tertiary surgical center in Germany. Results: From 1995-2000 to 2011-2015, significant declines (all P < 0.001) were noted in the percentage of node-positive tumors (from 73 to 49%), mediastinal lymph node metastasis (from 21 to 6%) and distant metastasis (from 23 to 6%). These changes were paralleled by significant increases (all P < 0.001) in mean patient age (from 49.1 to 57.3 years) and the percentage of MTC ≤10 mm (from 19 to 39%) and biochemical cure (from 28 to 62%). When only patients with primary tumors >10 mm were considered, the decreasing percentage of mediastinal lymph node metastasis and distant metastasis, and rising mean patient age and biochemical cure rates remained statistically significant. Conclusions: Significant reductions in the extent of the disease and improved biochemical cure rates pointed toward increasing therapeutic control of sporadic MTC. The independent contribution of routine calcitonin screening to these time-dependent changes warrants more research.