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This version published online on November 21, 2006
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2006-1590
A more recent version of this article appeared on February 1, 2007
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Submitted on July 21, 2006
Accepted on November 14, 2006

PREDICTIVE VALUE OF SERUM CALCITONIN LEVELS FOR PREOPERATIVE DIAGNOSIS OF MEDULLARY THYROID CARCINOMA IN A COHORT OF 5817 CONSECUTIVE PATIENTS WITH THYROID NODULES

Giuseppe Costante, Domenico Meringolo, Cosimo Durante, Davide Bianchi, Maria Nocera, Salvatore Tumino, Umberto Crocetti, Marco Attard, Marianna Maranghi, Massimo Torlontano, and Sebastiano Filetti*

Dipartimento di Medicina Sperimentale e Clinica, Università Magna Græcia, Catanzaro; Unità Operativa Semplice Dipartimentale di Endocrinologia, Ospedale di Bentivoglio, AUSL-BO, Bologna; Dipartimento di Scienze Cliniche, Università degli Studi di Roma "La Sapienza"; Divisione di Medicina Interna, Ospedale S. Giovanni di Dio, ASL 5, Crotone; Dipartimento di Scienze Mediche, Università di Catania; Divisione di Endocrinologia, IRCCS Casa Sollievo della Sofferenza, 71013 S. Giovanni Rotondo; Divisione di Endocrinologia, Ospedale Cervello, Palermo

* To whom correspondence should be addressed. E-mail: sebastiano.filetti{at}uniroma1.it.

Context: Routine serum calcitonin (CT) measurement in patients with thyroid nodules for diagnosis of medullary thyroid carcinoma (MTC) is controversial.

Objective: To evaluate the diagnostic accuracy of systematic CT measurement in non-MEN2 patients with nodular thyroid disease.

Settings: National Healthcare System hospital (outpatient and inpatient sectors)

Subjects: Consecutive patients with nodular thyroid disease (n = 5817).

Main Outcome Measures: Serum CT levels were measured under basal conditions and, when basal values were ≥ 20 < 100 pg/ml, testing was repeated after pentagastrin (PG) stimulation. Basal or stimulated levels > 100 pg/ml were indication for surgery.

Results: Fifteen cases of MTC and seven of C-cell hyperplasia (CCH) were identified. MTCs were diagnosed in all patients with basal CT > 100 pg/ml. The four patients with basal CT ≥ 50 < 100 pg/ml included two diagnosed with MTC and two with CCH. In ten patients with basal levels ≥ 20 < 50 pg/ml, histology confirmed the presence of MTC in four, four others had CCH, and the remaining two were negative for thyroid malignancy. Positive predictive values (PPV) for basal CT levels in the preoperative diagnosis of MTC were: 23.1% for values ≥ 20 pg/ml, 100% for values > 100 pg/ml, 25% for levels ≥ 50 < 100 pg/ml, and 8.3% for values ≥ 20 < 50 pg/ml. PPVs for the PG-test (> 100 pg/ml) were 40% in the entire series.

Conclusions: CT screening of thyroid nodules is a highly sensitive test for early diagnosis of MTC, but confirmatory stimulation testing is necessary in most cases to identify true positive increases.
Key words: medullary thyroid carcinoma • C-cell hyperplasia • thyroid nodule • calcitonin • pentagastrin test




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