Diagnostic accuracy of routine calcitonin measurement for the detection of medullary thyroid carcinoma in the management of patients with nodular thyroid disease: a meta-analysis

Abstract

Objective: The usefulness of routine calcitonin measurement for early detection of medullary thyroid carcinoma (MTC) in patients with nodular thyroid disease (NTD) has been investigated in various studies. Recently, a Cochrane review has been published on this issue, but a meta-analysis is lacking yet. Therefore, we performed this meta-analysis. Methods: We performed an electronic search using PubMed/Medline, Embase and the Cochrane Library. Studies assessing the diagnostic accuracy of routine calcitonin measurement for detecting MTC in patients with NDT were selected. Statistics were performed by using Stata software, risk of bias was assessed using Review Manager version 5.3. Results: 17 studies, involving 74,407 patients were included in the study. Meta-analysis, using the bivariate random effects model and the hierarchical summary receiver operating characteristic (HSROC) curve revealed the following pooled estimates: sensitivity 0.99 (95% CI, 0.81-1.00), specificity 0.99 (95% CI, 0.97-0.99), positive likelihood ratio (L+) 72.4 (95% CI, 32.3-162.1), and negative likelihood ratio (L-) 0.01 (95% CI, 0.00-0.23). Meta-regression analysis showed that the threshold of basal calcitonin is an independent factor, but in particular performing of stimulation test is not an independent factor. Conclusions: We showed that routine basal serum calcitonin measurement in the management of patients with thyroid nodules is valuable for the detection of MTC. However, the published cut-off values should be considered and, if applicable, the patients monitored in a wait-and-see strategy by experienced physicians to avoid overtreatment.

Medullary thyroid carcinoma: recent advances in identification, treatment, and prognosis

“… 11 These findings were supported with results from a recent meta-regression analysis. 13 However, Fugazzola et al 14 found that with using basal calcitonin cutoffs of >34 pg/mL for men and >30 pg/mL for women (area under curve 0.97 for men and 0.91 for women), the addition of calcium stimulation increased the sensitivity of MTC detection, particularly for patients with small MTC. In patients with thyroid nodular disease and basal calcitonin 10–100 pg/mL, stimulated calcitonin levels may be a useful adjunct to detect MTC and to facilitate appropriate initial surgery, although risks of potential overtreatment must be considered.…”

Basal and Calcium-Stimulated Procalcitonin for the Diagnosis of Medullary Thyroid Cancers: Lights and Shadows

“…Patients with a slightly elevated bCt (between 10 and 100 ng/L) and nodular thyroid disease are those in whom diagnosing MTC (often a micro-MTC) is more challenging. In cases with Ct values in the grey zone, some authors suggest a wait-and-see strategy to avoid overtreatment ( 26 ). Alternatively, a calcium stimulation test could be performed in such cases, though some authors question the usefulness of this approach.…”

The value of routine measurement of serum calcitonin on insufficient, indeterminate, and suspicious thyroid nodule cytology

“…Although the detection of MTC through routine calcitonin screening has recently been shown to lead to early stage diagnosis, the American Thyroid Association (ATA) guideline did not make recommendations for routine calcitonin measurement in nodular thyroid patients, leaving the decision up to the clinicians (13). However, many authorities recommend routine serum calcitonin measurement in nodular thyroid disease (4,9,10,17,19,20), but this recommendation is very controversial since it is considered that thyroid nodule prevalence is 33-68% (6,(21)(22)(23). In addition, the prevalence of MTC in nodular thyroid disease is unknown, and in thyroid cancers, its prevalence has been found to be 1-2% (1).…”