Measurement of Basal Serum Calcitonin for the Diagnosis of Medullary Thyroid Cancer

Allelein, Stephanie; Ehlers, Margret; Morneau, Corinna; Schwartz, Katharina; Goretzki, P. E.; Seppel, T; Feldkamp, Joachim; Krieg, Andreas; Knoefel, Wolfram Trudo; Kuebart, Anne; Dringenberg, Till; Schmid, Christine; Schott, M.

doi:10.1055/s-0043-122237

Cited by 38 publications

(24 citation statements)

References 39 publications

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“…60 pg/mL in men. These cut-offs were measured by using the newer calcitonin assays and were also confirmed by other working groups (3,4). This means a grey area for calcitonin of 20-30 pg/mL in women and 30-60 pg/mL in men, where 6-13% of smaller MTC were missed, but C-cell hyperplasia was diagnosed just as often.…”

supporting

confidence: 59%

Calcitonin Screening in Nodular Goiter—Upper Limits

Raue¹,

Frank‐Raue²

2018

Deutsches Ärzteblatt International

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In the description of calcitonin screening in nodular goiter, the specific dimension has to be considered when reporting the upper-limit values (conversion factor for calcitonin pg/ mL×0.28=pmol/L); this was corrected in issue 9. The article (1) reported a 95% probability for the presence of medullary thyroid carcinoma for limits of >26 pg/mL in women and >60 pg/mL in men-these data came from an original article by Mian et al. (2). Mian et al. used a receiver-operating characteristic curve (ROC) analysis of baseline calcitonin concentrations to test the best method for distinguishing normal persons and patients with medullary thyroid carcinoma and calculated a cut-off value of >26 pg/mL for women and >68 pg/mL for men.When sensitivity and specificity were taken into account, the sex-specific upper limits for baseline calcitonin concentrations that led to a recommendation to operate on the suspected sporadic medullary thyroid carcinoma (MTC) were ca. 30 pg/mL in women and ca. 60 pg/mL in men. These cut-offs were measured by using the newer calcitonin assays and were also confirmed by other working groups (3, 4). This means a grey area for calcitonin of 20-30 pg/mL in women and 30-60 pg/mL in men, where 6-13% of smaller MTC were missed, but C-cell hyperplasia was diagnosed just as often. This uncertainty can be overcome by checking calcitonin concentrations at 3-6 month intervals. Increasing calcitonin concentrations may indicate an MTC-in which case one should operate. There is no great urgency, however, since thyroidectomy can cure MTC in almost 100% of cases where the calcitonin concentration is below 100 pg/mL. Calcitonin screening should also be undertaken in any nodule that is smaller than 1 cm. MTC of a size of 0.4-0.6 cm tend to be associated with calcitonin concentrations of 20-100 pg/mL. DOI: 10.3238/arztebl.2018.0221a In Reply:We thank our correspondents for their contribution, which provides important additional information regarding the problem of raised serum calcitonin and the associated suspected presence of a medullary thyroid carcinoma (MTC).Our correspondents highlight in a concise way the current problems with the available data, and we fully agree with their comments. As our article (1) was, however, subject to a definite word limit and MTC accounts for less than 10% of all thyroid cancers, we were not able to conduct a comprehensive discussion of the subject. We-as coauthors of the cited article by S Allelein et al. (2)-are fully aware of the blurred delineation between suspicious findings and confirmation of an MTC of prognostic relevance, based on the baseline calcitonin concentration. In this context, the factors of influence pointed out by our correspondents-sex and the assay used for testing-are of enormous relevance.As MTC is, however, in any case a disorder that should conscientiously be excluded or confirmed pre-surgery, we, as surgeons and nuclear medicine specialists, recommend in cases of doubt a second opinion from an endocrinologist and to confirm the laboratory findings in a ...

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confidence: 59%

Calcitonin Screening in Nodular Goiter—Upper Limits

Raue¹,

Frank‐Raue²

2018

Deutsches Ärzteblatt International

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“…There is a possibility of false positive elevated calcitonin levels, and recent studies have evaluated the basal serum calcitonin cut-off thresholds for diagnosing MTC. Allelein et al (258) found that the most precise basal calcitonin thresholds for the identification of MTC were ≥ 10. wide grey-zones, and most importantly, if healing is to be achieved, the thyroidectomy must be performed before metastatic lymph nodes occur.…”

Section: Diagnostic Centers -Calcitonin Screeningmentioning

confidence: 99%

A Nationwide Study of Multiple Endocrine Neoplasia Type 2A in Norway: Predictive and Prognostic Factors for the Clinical Course of Medullary Thyroid Carcinoma

Opsahl

Brauckhoff

Schlichting

et al. 2016

Thyroid

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“…In the present study, using the reference range of the assay or adopting the traditional cut offs of 10, 15, or 20 pg/ml, only 16, 12, 5, and 3 patients, respectively, would require additional investigation without compromising the detection of the two cases of MTC. Thus, the adoption of a higher cut off such as 15 pg/ml [24,25] or 20 pg/ml [26][27][28] for basal Ctn would markedly reduce the number of false-positive cases and the need for additional investigation, without or only slightly affecting sensitivity. In the few patients who will still require additional investigation, stimulated Ctn (using calcium if pentagastrin is not available) and/ or FNA-Ctn could be obtained [19].…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Serum Calcitonin in Patients with Thyroid Nodules ≤ 1 cm Without an Indication for Fine-Needle Aspiration

2020

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Fine-needle aspiration (FNA) is not necessary in adults with nodules ≤ 1 cm without apparent extrathyroidal extension (ETE) or lymph node (LN) involvement on ultrasonography (US). In the absence of FNA and serum calcitonin (Ctn) measurement, medullary thyroid microcarcinomas (microMTC) are not diagnosed. The aim of this prospective study was to evaluate Ctn levels in adults with a low clinical risk of MTC and nodules ≤ 1 cm without ETE or LN involvement on US. A total of 506 consecutively seen adults who had nodules with two or more suspicious features were included. Patients with elevated basal Ctn underwent a calcium stimulation test and FNA. Basal Ctn was normal in 490 patients (96.8%). In the 16 patients with elevated basal Ctn, FNA revealed MTC in only one patient and MTC was not suspected in the 15 patients with elevated basal Ctn. Three patients with stimulated Ctn<100 pg/ml and benign cytology were not submitted to surgery. MTC was excluded by histology in three patients with stimulated Ctn<100 pg/ml and indeterminate or suspicious cytology and in eight patients with stimulated Ctn>100 pg/ml. One patient with stimulated Ctn>100 pg/ml had MTC. Ctn was undetectable 6 months after surgery in two patients with MTC. Although uncommon, even subjects without a suspicious history and with nodules ≤ 1 cm without ETE or LN involvement on US, but with suspicious findings, can have microMTC. The measurement of Ctn permits the diagnosis of these cases.

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Measurement of Basal Serum Calcitonin for the Diagnosis of Medullary Thyroid Cancer

Cited by 38 publications

References 39 publications

Calcitonin Screening in Nodular Goiter—Upper Limits

Calcitonin Screening in Nodular Goiter—Upper Limits

A Nationwide Study of Multiple Endocrine Neoplasia Type 2A in Norway: Predictive and Prognostic Factors for the Clinical Course of Medullary Thyroid Carcinoma

Usefulness of Serum Calcitonin in Patients with Thyroid Nodules ≤ 1 cm Without an Indication for Fine-Needle Aspiration

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