Calcitonin screening in patients with thyroid nodules

 

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Summary

Aim: The positive predictive value (PPV) of a slightly elevated basal calcitonin (CT) for the diagnosis of medullary thyroid cancer (MTC) is still under debate. Patients, methods: A total of 11 270 patients with thyroid nodules underwent calcitonin screening. Patients with known elevation of CT, renal insufficiency, bacterial infection, alcohol abuse, protonpump inhibitor therapy or autoimmune thyroid disease were excluded from further analysis. Serum CT was determined by the solid-phase, enzyme-labeled, two-site chemiluminescent immunoassay Immulite 2000. If possible, a pentagastrin test was done to differentiate cases of hypercalcitoninaemia. Results: Hypercalcitoninsemia was found in 32 patients. 20 patients underwent surgery. In 10 patients a MTC was found. The PPV of hyper calcitoninaemia for MTC was 31%. The PPV increased to 50% for those patients who underwent surgery (10/20). A subgroup of 26 patients presented with basal CT between 13 and 50 pg/ml, 14 of them underwent surgery, in 4 cases evidence of MTC was revealed. This resulted in a PPV of 15% (4/26), although the value increased to 28% when only surgically treated patients were considered (4/14). Conclusion: Taking all clinical data into account, calcitonin screening has an acceptable PPV for medullary thyroid cancer in patients with thyroid nodules. Therefore, we recommend calcitonin screening in centers for thyroid disorders.

Zusammenfassung

Ziel: Der positive Vorhersagewert (PPV) eines leicht erhöhten basalen Calcitonin-Spiegels (bCT) für das Vorliegen eines medullären Schilddrüsenkarzinoms (MTC) wird kontrovers diskutiert. Patienten und Methodik: 11 270 Patienten mit Schilddrüsenknoten erhielten eine Bestimmung des Calcitonin-Spiegels. Ausgeschlossen wurden Patienten mit bekannter Erhöhung des Calcitonin-Werts, Niereninsuffizienz, bakterieller Entzündung, Alkoholabusus, Einnahme von Protonenpumpen-Inhibitoren oder einer Autoimmunerkrankung der Schilddrüse. Der Serumspiegel für Calcitonin wurde mittels Chemilumineszenz-Verfahren (Immulite 2000®) bestimmt. Im Fall einer Hypercalcitoninämie wurde – sofern verfügbar und möglich – ein Pentagastrin-Stimulationstest durchgeführt. Ergebnisse: Eine Hyper - calcitoninämie wurde für 32 Patienten dokumentiert. 20 Patienten wurden operiert. Bei 10 Patienten wurde ein MTC histologisch gesichert. Der PPV eines erhöhten Calcitonin- Spiegels für das Vorliegen eines MTC war 31 %. Der PPV der Hypercalcitoninämie erhöhte sich auf 50 %, wenn nur die operierten Patienten (10/20) betrachtet wurden. Eine Untergruppe von 26 Patienten wies ein leicht erhöhtes bCT zwischen 13 and 50 pg/ml auf, von denen 14 Patienten operiert und bei 4 Patienten ein MTC histologisch gesichert wurde. Der PPV eines leicht erhöhten bCT für das Vorliegen eines MTC (4/26) lag bei 15 %. Der PPV eines leicht erhöhten bCT erhöhte sich auf 28 %, wenn nur die operierten Patienten (4/14) betrachtet wurden. Schlussfolgerung: Wenn man alle klinischen Informationen berücksichtigt, weist das Calcitonin-Screening bei Patienten mit Schilddrüsenknoten einen akzeptablen PPV für das Vorliegen eines MTC auf. Daher empfehlen wir das Calcitonin- Screening in Schilddrüsenzentren.

• References

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