Refining Calcium Test for the Diagnosis of Medullary Thyroid Cancer: Cutoffs, Procedures, and Safety

Mian, Caterina; Perrino, Michela; Colombo, Carla; Cavedon, Elisabetta; Pennelli, Gianmaria; Ferrero, Stefano; Leo, Simone De; Sarais, Cristiano; Cacciatore, Chiara; Manfredi, Gloria Irene; Verga, Uberta; Iacobone, Maurizio; Pasquale, Loredana De; Pelizzo, Maria Rosa; Vicentini, Leonardo; Persani, Luca; Fugazzola, Laura

doi:10.1210/jc.2013-4088

Cited by 99 publications

(80 citation statements)

References 18 publications

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“…An alternative method represents the calcium stimulation test, being described as sensitive as well, however, also having (potentially life threatening) side effects 17, 18. Additionally, cut‐offs for the calcium stimulation test are not yet well defined 19. All in all, a simple, safe and reliable complementary or alternative test to CT is warranted to increase the efficacy of a screening programme of thyroid nodules for MTC.…”

Section: Introductionmentioning

confidence: 99%

Procalcitonin measurement to screen medullary thyroid carcinoma: A prospective evaluation in a series of 2705 patients with thyroid nodules

Giovanella

Imperiali

Piccardo

et al. 2018

Eur J Clin Investigation

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BackgroundTo prospectively evaluate the role of procalcitonin (PCT) in screening of patients with thyroid nodules for medullary thyroid carcinoma (MTC).Materials and methodsWe measured PCT in 2705 patients with thyroid nodules referred to our centre between January 2011 and December 2017. Those with a positive PCT were operated after positive confirmatory tests such as fine‐needle aspiration, measurement of calcitonin (CT) in serum and fine‐needle aspiration washouts or CT stimulation testing. Patients with a negative PCT were operated based on the results of further diagnostics. The diagnostic performance of PCT was evaluated, and the best cut‐off level was selected by ROC curve analysis.ResultsAmong 2705 patients, 9 with positive serum PCT (ie, above 0.1 μg/L) and 370 with negative PCT underwent thyroid surgery. MTC was histologically confirmed in all patients with positive PCT but not found in patients with negative PCT. Serum PCT levels were significantly higher in patients with MTC (median 0.64 μg/L, range 0.16‐12.9 μg/L) than in those without (median 0.075 μg/L, range 0.075‐0.16 μg/L; P < .0001). ROC curves were plotted to calculate the optimal PCT value separating patients with MTC from those without. The best cut‐off was 0.155 μg/L with sensitivity, specificity, positive and negative predictive values as well as accuracy of 100%, 99.7%, 91.7%, 100% and 99.7%, respectively. Positive and negative likelihood ratios were 329 and zero, respectively.ConclusionsMeasurement of PCT is a sensitive and accurate method for detecting MTC in patients with thyroid nodules and can thus be a reliable alternative to CT measurement.

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Section: Introductionmentioning

confidence: 99%

Procalcitonin measurement to screen medullary thyroid carcinoma: A prospective evaluation in a series of 2705 patients with thyroid nodules

Giovanella

Imperiali

Piccardo

et al. 2018

Eur J Clin Investigation

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“…The thresholds for calcium stimulated Ct levels were > 544 and > 79 pg/mL in males and females, respectively [22]. In this study, the basal serum thresholds for PCt were defined as > 0.5 ng/mL (reference: 0.00 -0.50 ) and the threshold for calcium stimulated abnormal PCt levels were arbitrarily defined as three times the upper limit of normal plus the value for coefficient of variation ( > 1.65 ng/mL).…”

Section: Calcium Stimulation Testmentioning

confidence: 91%

“…The basal serum Ct level thresholds for the identification of MTC were defined as > 68 and > 26 pg/mL in males and females, respectively [22]. The thresholds for calcium stimulated Ct levels were > 544 and > 79 pg/mL in males and females, respectively [22].…”

Section: Calcium Stimulation Testmentioning

confidence: 99%

“…While a study by Mian et al [22] demonstrated preoperative basal serum concentrations of Ct of > 68 pg/mL in males and > 26 pg/mL in females were able to separate non-MTC from MTC cases, it is generally accepted by other investigators that only markedly elevated serum Ct level has high specificity. Although the calcium-pentagastrin stimulation test has a high sensitivity in the diagnosis of MTC, the limited availability of pentagastrin led to the popularity of the calcium stimulation test.…”

Section: Introductionmentioning

confidence: 97%

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Modified Fine-Needle Aspiration Biopsy for Calcitonin, Procalcitonin and Carcinoembryonic Antigen Levels in the Diagnosis of Thyroid Nodules With Medullary Thyroid Carcinoma

et al. 2017

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“…The calcium stimulation test can be used as an alternative (32) (B). Nevertheless, recent studies have shown that with the improved sensitivity of the new assays, both basal and stimulated calcitonin have similar accuracy, which reduces the relevance of the stimulation tests in multiple conditions (33) …”

Section: Recommendationmentioning

confidence: 99%

Diagnóstico, tratamento e seguimento do carcinoma medular de tireoide: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia

Maia

Siqueira

Kulcsar

et al. 2014

Arq Bras Endocrinol Metab

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Introduction: Medullary thyroid carcinoma (MTC) originates in the thyroid parafollicular cells and represents 3-4% of the malignant neoplasms that affect this gland. Approximately 25% of these cases are hereditary due to activating mutations in the REarranged during Transfection (RET) proto-oncogene. The course of MTC is indolent, and survival rates depend on the tumor stage at diagnosis. The present article describes clinical evidence-based guidelines for the diagnosis, treatment, and follow-up of MTC. Objective: The aim of the consensus described herein, which was elaborated by Brazilian experts and sponsored by the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism, was to discuss the diagnosis, treatment, and follow-up of individuals with MTC in accordance with the latest evidence reported in the literature. Materials and methods: After clinical questions were elaborated, the available literature was initially surveyed for evidence in the MedLine-PubMed database, followed by the Embase and Scientific Electronic Library Online/Latin American and Caribbean Health Science Literature (SciELO/Lilacs) databases. The strength of evidence was assessed according to the Oxford classification of evidence levels, which is based on study design, and the best evidence available for each question was selected. Results: Eleven questions corresponded to MTC diagnosis, 8 corresponded to its surgical treatment, and 13 corresponded to follow-up, for a total of 32 recommendations. The present article discusses the clinical and molecular diagnosis, initial surgical treatment, and postoperative management of MTC, as well as the therapeutic options for metastatic disease. Conclusions: MTC should be suspected in individuals who present with thyroid nodules and family histories of MTC, associations with pheochromocytoma and hyperparathyroidism, and/or typical phenotypic characteristics such as ganglioneuromatosis and Marfanoid habitus. Fine-needle nodule aspiration, serum calcitonin measurements, and anatomical-pathological examinations are useful for diagnostic confirmation. Surgery represents the only curative therapeutic strategy. The therapeutic options for metastatic disease remain limited and are restricted to disease control. Judicious postoperative assessments that focus on the identification of residual or recurrent disease are of paramount importance when defining the follow-up and later therapeutic management strategies. Arq Bras Endocrinol Metab. 2014;58(7):667-700

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Refining Calcium Test for the Diagnosis of Medullary Thyroid Cancer: Cutoffs, Procedures, and Safety

Cited by 99 publications

References 18 publications

Procalcitonin measurement to screen medullary thyroid carcinoma: A prospective evaluation in a series of 2705 patients with thyroid nodules

Procalcitonin measurement to screen medullary thyroid carcinoma: A prospective evaluation in a series of 2705 patients with thyroid nodules

Modified Fine-Needle Aspiration Biopsy for Calcitonin, Procalcitonin and Carcinoembryonic Antigen Levels in the Diagnosis of Thyroid Nodules With Medullary Thyroid Carcinoma

Diagnóstico, tratamento e seguimento do carcinoma medular de tireoide: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia

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