False positive results using calcitonin as a screening method for medullary thyroid carcinoma

Batista, Rafael Loch; Toscanini, Andrea Cecília; Brandão, Lenine Garcia; Cunha-Neto, Malebranche Berardo Carneiro da

doi:10.4103/2230-8210.111677

Cited by 8 publications

(5 citation statements)

References 21 publications

(43 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Follicular and papillary thyroid carcinomas could also be associated with CCH and slightly high calcitonin levels (70,71). Cases have also been reported of benign multinodular goiter with false positive calcitonin associated with neither CCH nor MTC in surgical specimens (72,73). Discordant data are reported for chronic autoimmune thyroiditis (74,75,76).…”

Section: False Positives and False Negativesmentioning

confidence: 94%

ENDOCRINE TUMOURS: Calcitonin in thyroid and extra-thyroid neuroendocrine neoplasms: the two-faced Janus

Giannetta

Guarnotta

Altieri

et al. 2020

European Journal of Endocrinology

View full text Add to dashboard Cite

An increased calcitonin serum level is suggestive of a medullary thyroid cancer (MTC), but is not pathognomonic. The possibility of false positives or other calcitonin-secreting neuroendocrine neoplasms (NENs) should be considered. Serum calcitonin levels are generally assessed by immunoradiometric and chemiluminescent assays with high sensitivity and specificity; however, slightly-moderately elevated levels could be attributable to various confounding factors. Calcitonin values >100 pg/mL are strongly suspicious of malignancy, whereas in patients with moderately elevated values (10-100 pg/mL) a stimulation test may be applied to improve diagnostic accuracy. Although the standard protocol and the best gender-specific cut-offs for calcium stimulated calcitonin are still controversial, the fold of the calcitonin increase after stimulation seems to be more reliable. Patients with MTC show stimulated calcitonin values at least 3-4 times higher than the basal values, whereas calcitonin-secreting NENs can be distinguished from a C-cell disease by the absence of or <2-fold response to stimulation. The measurement of calcitonin in fine-needle aspirate washout (FNA-CT) and calcitonin immunocytochemical staining from thyroid nodules are ancillary methods that may significantly improve MTC diagnosis. The present review examines the gray areas in the interpretation of calcitonin measurement in order to provide a tool to clarify the origin of calcitonin secretion and differentiate the behavior of the two-faced Janus of neuroendocrinology: intra-thyroid (MTC) and extra-thyroid NENs.

show abstract

Section: False Positives and False Negativesmentioning

confidence: 94%

ENDOCRINE TUMOURS: Calcitonin in thyroid and extra-thyroid neuroendocrine neoplasms: the two-faced Janus

Giannetta

Guarnotta

Altieri

et al. 2020

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…1 Calcitonin (CT) production is a characteristic feature of this tumor. However, several technical factors can affect the CT assay, and other nonthyroidal pathologic conditions can increase CT, 2,3 thus limiting its routine use in clinical practice. The American Thyroid Association (ATA) task force has confirmed that they could not make recommendations for or against the routine measurement of CT. 4 Furthermore, the American Association of Clinical Endocrinologists/Associazione Medici Endocrinologi/European Thyroid Association (AACE/AME/ ETA) guidelines have suggested examining CT only in subjects with a familial history of MTC and patients with cytology suggestive of MTC or undergoing surgery for goiter.…”

Section: Introductionmentioning

confidence: 99%

“…Calcitonin (CT) production is a characteristic feature of this tumor. However, several technical factors can affect the CT assay, and other nonthyroidal pathologic conditions can increase CT, 2,3 thus limiting its routine use in clinical practice. The American Thyroid Association (ATA) task force has confirmed that they could not make recommendations for or against the routine measurement of CT 4 .…”

Section: Introductionmentioning

confidence: 99%

An old friend, a new insight: Calcitonin measurement in serum and aspiration needle washout fluids significantly increases the early and accurate detection of medullary thyroid cancer

Ogmen,

Ince,

Aksoy Altınboga

et al. 2023

Cancer Cytopathology

View full text Add to dashboard Cite

BackgroundThe sensitivity of cytological (CY) evaluation after fine‐needle aspiration (FNA) for detecting medullary thyroid carcinoma (MTC) is a subject of controversy. The routine use of serum calcitonin (CT) in patients with thyroid nodules is not universally adopted. The authors conducted CT screening of FNA washout fluid (FNA‐CT) to address the diagnostic challenges. The objective was to assess the contributions of serum CT, FNA cytology (FNA‐CY), and FNA‐CT to the diagnosis.MethodsBetween February 2019 and June 2022 (group 1), the authors prospectively screened the CT of patients with thyroid nodules. Both FNA‐CY and FNA‐CT were performed for patients with persistently elevated CT values. The sensitivity of FNA‐CY, serum CT, and FNA‐CT for accurate diagnosis was evaluated. Additionally, the authors retrospectively examined data from patients with thyroid nodules before CT screening (2008–2019) (group 2). They compared the characteristics of MTC patients in groups 1 and 2.ResultsMTC was identified in 30 patients (0.25%) in group 1 and 19 (0.07%) in group 2. A FNA‐CT cutoff value of 4085.5 pg/mL detected MTC with a sensitivity of 96.8%, and a serum CT cutoff value of 28.3 pg/mL detected MTC with a sensitivity of 86.7%. In contrast, FNA‐CY detected MTC with a sensitivity of 42.4%. In group 1, 18 patients (60%) with MTC were diagnosed with microcarcinoma, whereas only two patients (10.5%) in group 2 had microcarcinoma.ConclusionsThis study detected MTC earlier by routinely measuring serum CT in all patients with nodular thyroid disease and performing FNA‐CT in those with elevated values. FNA‐CT and serum CT sensitivities were significantly higher than those of FNA‐CY. This study revealed different FNA‐CT cutoff values compared to other studies, emphasizing the need for determining clinic‐specific cutoff values.

show abstract

“…Lastly, false positives may occur frequently in both basal and stimulated measurements of calcitonin [ 6 ]. Benign pathologies causing an increase in calcitonin levels include benign hyperplasia of C cells, benign thyroid nodules, differentiated thyroid carcinoma and Hashimoto thyroiditis [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Carcinoembryonic antigen levels correlated with advanced disease in medullary thyroid cancer

Turkdogan

Forest

Hier

et al. 2018

Journal of Otolaryngology - Head & Neck Surgery

View full text Add to dashboard Cite

BackgroundMedullary thyroid cancer (MTC) cells are capable of secreting various tumor markers including calcitonin and carcinoembyronic antigen (CEA). The purpose of this study is to determine whether abnormal CEA levels may be used as a tumor marker to predict the severity of disease in MTC.MethodsA retrospective analysis was completed for 33 patients with MTC who had preoperative serum CEA levels. Univariate and multivariate analyses were used to quantify the relationship between serum CEA levels and tumor stage and prognosis.ResultsOn multivariate analysis, elevated preoperative CEA levels were significantly associated with the size and stage of tumor, distant metastasis, decreased biochemical cure, and mortality. There was a significant association between tumor size greater than 37 mm and elevated CEA levels (> 271 ng/ml). There was also a positive correlation with increased cancer stage (> 377 ng/ml), distant metastasis (> 405 ng/ml), and contralateral compartment location of lymph node metastasis (> 162 ng/ml). When pre-operative CEA levels are > 500 ng/ml, patient mortality was 67%.ConclusionIn this study, both pre-operative calcitonin and CEA levels were significantly correlated with the extent of disease in MTC. While calcitonin has a linear relationship with disease progression, abnormal CEA levels were a better indicator of advanced disease. CEA levels > 271 ng/ml are significant for advanced tumor size and staging, metastasis to the central compartment, and decreased chance of biochemical cure. CEA levels greater than 500 ng/ml are associated with significant patient mortality.

show abstract

False positive results using calcitonin as a screening method for medullary thyroid carcinoma

Cited by 8 publications

References 21 publications

ENDOCRINE TUMOURS: Calcitonin in thyroid and extra-thyroid neuroendocrine neoplasms: the two-faced Janus

ENDOCRINE TUMOURS: Calcitonin in thyroid and extra-thyroid neuroendocrine neoplasms: the two-faced Janus

An old friend, a new insight: Calcitonin measurement in serum and aspiration needle washout fluids significantly increases the early and accurate detection of medullary thyroid cancer

Carcinoembryonic antigen levels correlated with advanced disease in medullary thyroid cancer

Contact Info

Product

Resources

About