Calculation and Validation of a Plasma Calcitonin Limit for Early Detection of Medullary Thyroid Carcinoma in Nodular Thyroid Disease

Rink, Thomas; Truong, P. N.; Schroth, H.-J.; Diener, Jürgen; Zimny, M.; Grünwald, Frank

doi:10.1089/thy.2008.0102

Cited by 56 publications

(44 citation statements)

References 21 publications

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“…This observation explains why men outnumbered women in the sporadic C-cell hyperplasia group by more than eightfold (66 men versus 8 women; P!0.001), whereas women predominated twofold in the occult medullary thyroid cancer group (18 women versus 8 men; Table 1). Similar gender-specific disparities have been reported elsewhere (Rink et al 2009, Scheuba et al 2009). In this study, increased basal calcitonin levels of %50 pg/ml for men were associated with much poorer positive predictive values for occult medullary thyroid cancer.…”

Section: Gender-specific Disparities In Calcitonin Secretionsupporting

confidence: 88%

“…Because male thyroids harbor more C-cells than female thyroids, serum calcitonin levels are more often higher in men than women (Heath & Sizemore 1977, Hahm et al 2001, Vierhapper et al 2005, Weinhaeusel et al 2008, Rink et al 2009, Scheuba et al 2009). This observation explains why men outnumbered women in the sporadic C-cell hyperplasia group by more than eightfold (66 men versus 8 women; P!0.001), whereas women predominated twofold in the occult medullary thyroid cancer group (18 women versus 8 men; Table 1).…”

Section: Gender-specific Disparities In Calcitonin Secretionmentioning

confidence: 99%

“…(a) a basal calcitonin level within normal limits of the assay practically excludes medullary thyroid cancer (Elisei et al 2004, Rink et al 2009, Scheuba et al 2009) (b) the likelihood of medullary thyroid cancer is remote when stimulated calcitonin levels are !100 pg/ml (Hahm et al 2001, Karges et al 2004, Vierhapper et al 2005, Rink et al 2009, Scheuba et al 2009) (c) raising calcitonin thresholds lowers the rate of false positives at the cost of missing more subclinical disease (Iacobone et al 2002, Karges et al 2004, Vierhapper et al 2005, Costante et al 2007, Cheung et al 2008, Rink et al 2009). …”

Section: A Machens F Hoffmann Et Al: Calcitonin Thresholds In Mtc Smentioning

confidence: 99%

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Importance of gender-specific calcitonin thresholds in screening for occult sporadic medullary thyroid cancer

Machens¹,

Hoffmann²,

Sekulla³

et al. 2009

Endocrine-Related Cancer

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Men and women differ in thyroidal C-cell mass and calcitonin secretion. This difference may have implications for the definition of calcitonin thresholds to distinguish sporadic C-cell hyperplasia from occult medullary thyroid cancer. This retrospective study examined the hypothesis that gender-specific calcitonin thresholds predict occult medullary thyroid cancer more accurately among patients with increased basal calcitonin levels than unisex thresholds. A total of 100 consecutive patients were evaluated with occult sporadic C-cell disease no larger than 10 mm who were referred for increased basal calcitonin levels and underwent pentagastrin stimulation preoperatively at this institution. Altogether, gender-specific calcitonin thresholds predicted medullary thyroid cancer better than unisex thresholds. At lower (%50 pg/ml basally; %500 pg/ml after stimulation), but not higher, calcitonin serum levels, women revealed medullary thyroid cancer four to eight times more often than men. Most discriminatory between C-cell hyperplasia and medullary thyroid cancer was a basal calcitonin threshold of 15 pg/ml (corrected 20 pg/ml) for women and 80 pg/ml (corrected 100 pg/ml) for men, based on the greatest accuracy at the lowest possible calcitonin level. The respective gender-specific stimulated peak calcitonin thresholds were 80 pg/ml (corrected 100 pg/ml) and 500 pg/ml. Corresponding positive predictive values for medullary thyroid cancer at these calcitonin thresholds were 89 and 90% for women, as opposed to 100% for men. To increase the positive predictive value for women to 100%, the respective calcitonin thresholds would have to be raised to 40 pg/ml (corrected 50 pg/ml) and 250 pg/ml. These findings indicate that gender-specific calcitonin thresholds predict sporadic occult medullary thyroid cancer better than unisex thresholds.

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Section: Gender-specific Disparities In Calcitonin Secretionsupporting

confidence: 88%

Section: Gender-specific Disparities In Calcitonin Secretionmentioning

confidence: 99%

Section: A Machens F Hoffmann Et Al: Calcitonin Thresholds In Mtc Smentioning

confidence: 99%

See 1 more Smart Citation

Importance of gender-specific calcitonin thresholds in screening for occult sporadic medullary thyroid cancer

Machens¹,

Hoffmann²,

Sekulla³

et al. 2009

Endocrine-Related Cancer

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“…In the last few years, several studies revealed different upper limits of basal hCT values to detect MTC and to reduce false-positive cases (12)(13)(14)(15). The present study sheds further light on the hCT measurement and its testing after pentagastrin stimulation in patients with thyroid nodule disease.…”

Section: Introductionmentioning

confidence: 54%

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

Herrmann¹,

Schmid²,

Goerges³

et al. 2010

European Journal of Endocrinology

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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.

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“…In contrast, PPV of stimulated sCT > 100 pg/mL is controversial. Although some studies reported PPV of 100% (8,10,20), many series found a value of only 25% (21), 20% (22), and 0/13 (9) in patients with elevated basal sCT, but < 100 pg/mL, who converted to levels > 100 pg/mL after stimulation. As a consequence, different cutoffs of stimulated sCT have been proposed in the literature (11)(12)(13)15,19), and this value remains undefined.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of preoperative serum calcitonin in patients with nodular thyroid disease without suspicious history or cytology for medullary thyroid carcinoma

Rosário

Penna

Brandão

et al. 2013

Arq Bras Endocrinol Metab

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Patients and methods: sCT was measured before thyroidectomy in 494 patients with nodular disease who had no family history of MTC or multiple endocrine neoplasia type 2, and no cytological suspicion of MTC. Results: Basal sCT was < 10 ng/mL in 482 patients and none of them had MTC. One patient with basal sCT > 100 pg/mL had MTC. Among the 11 patients with basal sCT between 10 and 100 pg/mL, MTC was diagnosed in only one. The two patients with MTC were submitted to total thyroidectomy, combined with elective lymph node dissection indicated exclusively based on hypercalcitoninemia, and sCT was undetectable after six months. Conclusions: Preoperative sCT is useful for the detection of sporadic MTC in patients with nodular disease, even in the absence of suspicious history or cytology. Arq Bras Endocrinol Metab. 2013;57(4):312-6 Keywords Calcitonin; medullary carcinoma; nodular disease RESUMO Objetivo: Avaliar a utilidade da calcitonina sérica (sCT) pré-operatória em pacientes com doença nodular sem suspeita de carcinoma medular de tireoide (CMT) pela história e citologia. Pacientes e métodos: Antes da tireoidectomia, sCT foi dosada em 494 pacientes com doença nodular, sem história familiar de CMT ou neoplasia endócrina múltipla tipo 2 e sem citologia suspeita para CMT. Resultados: sCT basal foi < 10 ng/ml em 482 pacientes e nenhum possuía CMT. Um paciente com sCT basal > 100 pg/ml realmente possuía CMT. Dos 11 pacientes com sCT basal entre 10 e 100 pg/ml, CMT foi diagnosticado em apenas um. Os dois pacientes com CMT foram submetidos à tireoidectomia total com dissecção eletiva de linfonodos, indicada exclusivamente pela hipercalcitoninemia, e após seis meses apresentaram sCT indetectável. Conclusões: Em pacientes com doença nodular, mesmo sem história ou citologia suspeitas, a sCT pré-operatória é útil para detecção do CMT esporádico. Arq Bras Endocrinol Metab. 2013;57(4):312-6 Descritores Calcitonina; carcinoma medular; doença nodular

show abstract

Calculation and Validation of a Plasma Calcitonin Limit for Early Detection of Medullary Thyroid Carcinoma in Nodular Thyroid Disease

Abstract: An upper limit of 15 ng/L instead of 10 ng/L for basal pCT-C is able to detect all MTC and reduce false-positive cases. The prevalence of MTC in nodular thyroid disease in our group was approximately 1.8 per thousand.

Cited by 56 publications

References 21 publications

Importance of gender-specific calcitonin thresholds in screening for occult sporadic medullary thyroid cancer

Importance of gender-specific calcitonin thresholds in screening for occult sporadic medullary thyroid cancer

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

Usefulness of preoperative serum calcitonin in patients with nodular thyroid disease without suspicious history or cytology for medullary thyroid carcinoma

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