Evaluation of Routine Basal Serum Calcitonin Measurement for Early Diagnosis of Medullary Thyroid Carcinoma in Seven Hundred Seventy-Three Patients with Nodular Goiter

Özgen, A. Gökhan; Hamulu, Füsun; Bayraktar, Fırat; Yılmaz, Candeğer; Tüzün, Mehmet; Yetkin, Enis; Tunçyürek, Müge; Kabalak, Taylan

doi:10.1089/thy.1999.9.579

Cited by 86 publications

(51 citation statements)

References 17 publications

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“…Falsenegative reports in fine-needle aspiration may occur in the case of thyroid malignancy, both in large nodules and in microcarcinomas, tumors !10 mm in diameter (33). Nevertheless, fine-needle aspiration should be recommended considering the fact that one of the two MTCs in our study was 3 mm, and could be detected positively by cytology.…”

Section: Discussionmentioning

confidence: 64%

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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Section: Discussionmentioning

confidence: 64%

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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“…Routine calcitonin measurements show a higher sensitivity compared with fine needle aspiration cytology, especially in diagnosing small (%10 mm) medullary thyroid cancer (Pacini et al 1994, Niccoli et al 1997, Ozgen et al 1999, Bugalho et al 2005, Papi et al 2006. The costs of initial 'calcitonin screening' in patients with thyroid nodules independent of their size have to be balanced against that of multiple surgical procedures, and arguably worthwhile, but none-the-less frequently used, radiation and chemotherapy in patients with metastatic disease, as well as against the psychological effects of a 'chronic' disease (Dunn 1994, Horvit & Gagel 1997, Vierhapper et al 1997.…”

Section: Routine Calcitonin Determinations ('Calcitonin Screening') Omentioning

confidence: 99%

“…Normal basal calcitonin values of !10 pg/ml practically exclude medullary thyroid cancer (Pacini et al 1994, Rieu et al 1995, Niccoli et al 1997, Kaserer et al 1998, Ozgen et al 1999, Hahm et al 2001, Iacobone et al 2002. Therefore, basal calcitonin levels of R10 pg/ml were used as the initial diagnostic tool to stratify for medullary thyroid cancer risk and this was defined as upper normal reference limit in most of the studies (Demers & Spencer 2003).…”

Section: Normal Calcitonin Levels and Medullary Thyroid Cancermentioning

confidence: 99%

“…Patients with stimulated calcitonin levels of 30 -100 pg/ml have a low risk (!3%) for sporadic medullary thyroid cancer (Barbot et al 1994, Iacobone et al 2002. The risk for medullary thyroid cancer is greater than 50% in patients with stimulated calcitonin values O100 pg/ml (Costante et al 2007), quoting a minimal prevalence of medullary thyroid cancer of 0.26-1.37% (Pacini et al 1994, Rieu et al 1995, Niccoli et al 1997, Vierhapper et al 1997, Ozgen et al 1999, Hahm et al 2001, Papi et al 2006, Costante et al 2007. A higher stimulated calcitonin cut-off level (e.g., 200 pg/ml (Iacobone et al 2002) would further increase the positive predictive value for medullary thyroid cancer, but more than a third of medullary thyroid cancers would escape diagnosis and treatment (Iacobone et al 2002).…”

Section: Normal Calcitonin Levels and Medullary Thyroid Cancermentioning

confidence: 99%

“…Despite the ever increasing number of publications recommending routine calcitonin measurements in patients with thyroid nodules to diagnose medullary thyroid cancer in an early and therefore curable stage (Pacini et al 1994, Rieu et al 1995, Niccoli et al 1997, Vierhapper et al 1997, 2005, Ozgen et al 1999, Hahm et al 2001, Elisei et al 2004, Papi et al 2006, Costante et al 2007, 'calcitonin screening' is not recommended in daily practice (Hegedus 2004). Differences exist in the literature (Scheuba et al 1999, Iacobone et al 2002, Costante et al 2007) regarding calcitonin cut-off levels, indication, time, and extent of surgery.…”

Section: Introductionmentioning

confidence: 99%

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Sporadic hypercalcitoninemia: clinical and therapeutic consequences

Scheuba¹,

Kaserer²,

Moritz³

et al. 2009

Endocrine-Related Cancer

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Abstract'Calcitonin screening' is not accepted as the standard of care in daily practice. The clinical and surgical consequences of 'calcitonin screening' in a series of patients with mildly elevated basal calcitonin and pentagastrin stimulated calcitonin levels are presented. 260 patients with elevated basal (O10 pg/ml) and stimulated calcitonin levels (O100 pg/ml) were enrolled in this prospective study. None of the patients was member of a known medullary thyroid carcinoma family. Thyroidectomy and bilateral central and lateral neck dissections were performed. Testing for the presence of germ-line mutations was performed in all patients. Histological and immunohistochemical findings were compared with basal and stimulated calcitonin levels. All patients were subsequently followed biochemically. C-cell hyperplasia (CCH) was found in 126 (49%) and medullary thyroid cancer was found in 134 (51%) patients. RET proto-oncogen mutations were documented in 22 (8%) patients (medullary thyroid cancer:18, CCH:4). In 56 (46%) of 122 patients, sporadic CCH was classified neoplastic ('carcinoma in situ'). Of 97 (72%; 10 with hereditary medullary thyroid cancer) had pT1 (International Union against Cancer recommendations 2002) and 33 (25%) had pT2 or pT3 and 4 (3%) pT4 tumors. Of 39 (29.1%) had lymph node metastases. 106 (79.1%; 15 (38.5%) with lymph node metastases) patients were cured. Evaluation of basal and stimulated calcitonin levels enables the prediction of medullary thyroid cancer. All patients with basal calcitonin O64 pg/ml and stimulated calcitonin O560 pg/ml have medullary thyroid cancer. Medullary thyroid cancer was documented in 20% of patients with basal calcitonin O10 pg/ml but !64 pg/ml and stimulated calcitonin O100 pg/ml but !560 pg/ml.

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Calcitonin testing for detection of medullary thyroid cancer in people with thyroid nodules

Verbeek

Groot

Sluiter

et al. 2020

Cochrane Database of Systematic Reviews

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Evaluation of Routine Basal Serum Calcitonin Measurement for Early Diagnosis of Medullary Thyroid Carcinoma in Seven Hundred Seventy-Three Patients with Nodular Goiter

Cited by 86 publications

References 17 publications

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

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

Sporadic hypercalcitoninemia: clinical and therapeutic consequences

Calcitonin testing for detection of medullary thyroid cancer in people with thyroid nodules

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