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, Sebastiano Filetti

Research output: Contribution to journalArticle

192 Citations (Scopus)

Abstract

Context: Routine serum calcitonin (CT) measurement in patients with thyroid nodules for diagnosis of medullary thyroid carcinoma (MTC) is controversial. Objective: The objective of this study was to evaluate the diagnostic accuracy of systematic CT measurement in non-multiple endocrine neoplasia type 2 patients with nodular thyroid disease. Settings: This study was conducted at a national healthcare system hospital (outpatient and inpatient sectors). Subjects: Consecutive patients with nodular thyroid disease (n = 5817) were studied. Main Outcome Measures: Serum CT levels were measured under basal conditions, and when basal values were more than or equal to 20 and less than 100 pg/ml, testing was repeated after pentagastrin stimulation. Basal or stimulated levels more than 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 more than 100 pg/ml. The four patients with basal CT more than or equal to 50 and less than 100 pg/ml included two diagnosed with MTC and two with CCH. In 10 patients with basal levels more than or equal to 20 and less than 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 for basal CT levels in the preoperative diagnosis of MTC were: 23.1% for values more than or equal to 20 pg/ml, 100% for values more than 100 pg/ml, 25% for levels more than or equal to 50 and less than 100 pg/ml, and 8.3% for values more than or equal to 20 and less than 50 pg/ml. Positive predictive values for the pentagastrin 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.

Original languageEnglish
Pages (from-to)450-455
Number of pages6
JournalJournal of Clinical Endocrinology and Metabolism
Volume92
Issue number2
DOIs
Publication statusPublished - Feb 2007

Fingerprint

Thyroid Nodule
Calcitonin
Serum
Hyperplasia
Pentagastrin
Thyroid Diseases
Predictive Value of Tests
Histology
Testing
Medullary Thyroid cancer
Surgery
Inpatients
Early Diagnosis
Neoplasms
Screening
Thyroid Gland
Outpatients
Outcome Assessment (Health Care)
Delivery of Health Care

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

Predictive value of serum calcitonin levels for preoperative diagnosis of medullary thyroid carcinoma in a cohort of 5817 consecutive patients with thyroid nodules. / Costante, Giuseppe; Meringolo, Domenico; Durante, Cosimo; Bianchi, Davide; Nocera, Maria; Tumino, Salvatore; Crocetti, Umberto; Attard, Marco; Maranghi, Marianna; Torlontano, Massimo; Filetti, Sebastiano.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 92, No. 2, 02.2007, p. 450-455.

Research output: Contribution to journalArticle

Costante, Giuseppe ; Meringolo, Domenico ; Durante, Cosimo ; Bianchi, Davide ; Nocera, Maria ; Tumino, Salvatore ; Crocetti, Umberto ; Attard, Marco ; Maranghi, Marianna ; Torlontano, Massimo ; Filetti, Sebastiano. / Predictive value of serum calcitonin levels for preoperative diagnosis of medullary thyroid carcinoma in a cohort of 5817 consecutive patients with thyroid nodules. In: Journal of Clinical Endocrinology and Metabolism. 2007 ; Vol. 92, No. 2. pp. 450-455.
@article{1874de711e7f42d0886852d9d09085f5,
title = "Predictive value of serum calcitonin levels for preoperative diagnosis of medullary thyroid carcinoma in a cohort of 5817 consecutive patients with thyroid nodules",
abstract = "Context: Routine serum calcitonin (CT) measurement in patients with thyroid nodules for diagnosis of medullary thyroid carcinoma (MTC) is controversial. Objective: The objective of this study was to evaluate the diagnostic accuracy of systematic CT measurement in non-multiple endocrine neoplasia type 2 patients with nodular thyroid disease. Settings: This study was conducted at a national healthcare system hospital (outpatient and inpatient sectors). Subjects: Consecutive patients with nodular thyroid disease (n = 5817) were studied. Main Outcome Measures: Serum CT levels were measured under basal conditions, and when basal values were more than or equal to 20 and less than 100 pg/ml, testing was repeated after pentagastrin stimulation. Basal or stimulated levels more than 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 more than 100 pg/ml. The four patients with basal CT more than or equal to 50 and less than 100 pg/ml included two diagnosed with MTC and two with CCH. In 10 patients with basal levels more than or equal to 20 and less than 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 for basal CT levels in the preoperative diagnosis of MTC were: 23.1{\%} for values more than or equal to 20 pg/ml, 100{\%} for values more than 100 pg/ml, 25{\%} for levels more than or equal to 50 and less than 100 pg/ml, and 8.3{\%} for values more than or equal to 20 and less than 50 pg/ml. Positive predictive values for the pentagastrin 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.",
author = "Giuseppe Costante and Domenico Meringolo and Cosimo Durante and Davide Bianchi and Maria Nocera and Salvatore Tumino and Umberto Crocetti and Marco Attard and Marianna Maranghi and Massimo Torlontano and Sebastiano Filetti",
year = "2007",
month = "2",
doi = "10.1210/jc.2006-1590",
language = "English",
volume = "92",
pages = "450--455",
journal = "Journal of Clinical Endocrinology and Metabolism",
issn = "0021-972X",
publisher = "The Endocrine Society",
number = "2",

}

TY - JOUR

T1 - Predictive value of serum calcitonin levels for preoperative diagnosis of medullary thyroid carcinoma in a cohort of 5817 consecutive patients with thyroid nodules

AU - Costante, Giuseppe

AU - Meringolo, Domenico

AU - Durante, Cosimo

AU - Bianchi, Davide

AU - Nocera, Maria

AU - Tumino, Salvatore

AU - Crocetti, Umberto

AU - Attard, Marco

AU - Maranghi, Marianna

AU - Torlontano, Massimo

AU - Filetti, Sebastiano

PY - 2007/2

Y1 - 2007/2

N2 - Context: Routine serum calcitonin (CT) measurement in patients with thyroid nodules for diagnosis of medullary thyroid carcinoma (MTC) is controversial. Objective: The objective of this study was to evaluate the diagnostic accuracy of systematic CT measurement in non-multiple endocrine neoplasia type 2 patients with nodular thyroid disease. Settings: This study was conducted at a national healthcare system hospital (outpatient and inpatient sectors). Subjects: Consecutive patients with nodular thyroid disease (n = 5817) were studied. Main Outcome Measures: Serum CT levels were measured under basal conditions, and when basal values were more than or equal to 20 and less than 100 pg/ml, testing was repeated after pentagastrin stimulation. Basal or stimulated levels more than 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 more than 100 pg/ml. The four patients with basal CT more than or equal to 50 and less than 100 pg/ml included two diagnosed with MTC and two with CCH. In 10 patients with basal levels more than or equal to 20 and less than 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 for basal CT levels in the preoperative diagnosis of MTC were: 23.1% for values more than or equal to 20 pg/ml, 100% for values more than 100 pg/ml, 25% for levels more than or equal to 50 and less than 100 pg/ml, and 8.3% for values more than or equal to 20 and less than 50 pg/ml. Positive predictive values for the pentagastrin 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.

AB - Context: Routine serum calcitonin (CT) measurement in patients with thyroid nodules for diagnosis of medullary thyroid carcinoma (MTC) is controversial. Objective: The objective of this study was to evaluate the diagnostic accuracy of systematic CT measurement in non-multiple endocrine neoplasia type 2 patients with nodular thyroid disease. Settings: This study was conducted at a national healthcare system hospital (outpatient and inpatient sectors). Subjects: Consecutive patients with nodular thyroid disease (n = 5817) were studied. Main Outcome Measures: Serum CT levels were measured under basal conditions, and when basal values were more than or equal to 20 and less than 100 pg/ml, testing was repeated after pentagastrin stimulation. Basal or stimulated levels more than 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 more than 100 pg/ml. The four patients with basal CT more than or equal to 50 and less than 100 pg/ml included two diagnosed with MTC and two with CCH. In 10 patients with basal levels more than or equal to 20 and less than 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 for basal CT levels in the preoperative diagnosis of MTC were: 23.1% for values more than or equal to 20 pg/ml, 100% for values more than 100 pg/ml, 25% for levels more than or equal to 50 and less than 100 pg/ml, and 8.3% for values more than or equal to 20 and less than 50 pg/ml. Positive predictive values for the pentagastrin 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.

UR - http://www.scopus.com/inward/record.url?scp=33846964878&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33846964878&partnerID=8YFLogxK

U2 - 10.1210/jc.2006-1590

DO - 10.1210/jc.2006-1590

M3 - Article

VL - 92

SP - 450

EP - 455

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

SN - 0021-972X

IS - 2

ER -