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

Abstract

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.

Calcitonin negative medullary thyroid cancer in ectopic thyroid tissue: a rare diagnosis in an unusual location

“…It is recognised that measurement of this biomarker can allow earlier diagnosis than with imaging and fine needle aspiration (FNA). 4 In our case, not only was serum CT negative, but it was also shown to be negative on immunohistochemical staining of excised tissue. Immunohistochemistry is crucial in the diagnosis of CNMTC with particular attention given to markers shown in the investigations above.…”

“…1 Pro-CT is the precursor of CT and has been shown to be a sensitive, reliable alternative to CT and is currently of most diagnostic use. 4 CGRP is secreted by MTC but also non-neoplastic C cells, and therefore may be of most use as an adjunct to diagnosis. 1…”

“…3 The concentration of serum CT will reflect the mass and activity of C cells. 4 CEA is less reliable and may be in the normal range in patients with advanced, metastatic MTC. 5 Like other neuroendocrine tumours, MTC can also produce a range of relevant biomarkers, such as procalcitonin (Pro-CT), neuron-specific elonase and chromogranin A (CgA).…”

Clinical performance of calcitonin and procalcitonin Elecsys® immunoassays in patients with medullary thyroid carcinoma

“…Procalcitonin (PCT), the precursor of CT, circulates at low concentrations in healthy individuals; moreover, it has a concentration-independent and predictable in vivo half-life of 20-24 h and displays excellent in vitro stability in serum or plasma [11,12]. A strong correlation between PCT and CT levels was proven in patients with MCT and multiple studies confirmed equivalent high sensitivity of CT and PCT in detecting and monitoring MTC [13][14][15]. On balance, the above-mentioned studies suggested that PCT, being less affected by analytical, physiological, pharmacological and pathological factors that can influence results of serum CT values, could be a new standard of care in the management of MTC [16][17][18][19].…”

Procalcitonin as Marker of Recurrent Medullary Thyroid Carcinoma: A Systematic Review and Meta-Analysis

“…Thus, other MTC serum markers have been proposed, and ProCT has appeared as promising [ 6 ]. Interesting papers evaluated the role of ProCT in terms of prognosis and diagnosis of MTC with encouraging findings [ 30 31 ]. However, further studies are needed to reach evidence on its potential use for the initial assessment of MTC.…”