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Calcitonin screening in patients with thyroid nodules. Diagnostic value
C Schneider1, C Kobe, M Schmidt
1Department of Nuclear Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany. christina.schneider_@uk-koeln.de
Nuklearmedizin. Nuclear Medicine
|September 4, 2012
Summary
Calcitonin screening for medullary thyroid cancer (MTC) in patients with thyroid nodules shows an acceptable positive predictive value (PPV). This supports its use in specialized thyroid disorder centers.
Area of Science:
- Endocrinology
- Oncology
- Diagnostic Medicine
Background:
- The diagnostic accuracy of elevated basal calcitonin (CT) for medullary thyroid cancer (MTC) remains debated.
- Thyroid nodules are common, necessitating reliable diagnostic tools for MTC.
Purpose of the Study:
- To evaluate the positive predictive value (PPV) of basal calcitonin (CT) screening for medullary thyroid cancer (MTC) in patients with thyroid nodules.
- To determine the effectiveness of CT screening in a large patient cohort.
Main Methods:
- A cohort of 11,270 patients with thyroid nodules underwent serum CT screening.
- Exclusion criteria included elevated CT from other causes, renal insufficiency, and specific medications.
- Serum CT levels were measured using a chemiluminescent immunoassay, with pentagastrin testing for ambiguous cases.
Main Results:
- Hypercalcitoninemia was detected in 32 patients, with 10 confirmed MTC cases (overall PPV of 31%).
- For patients who underwent surgery, the PPV increased to 50%.
- In a subgroup with basal CT between 13-50 pg/ml, the PPV was 15%, rising to 28% for surgically treated patients.
Conclusions:
- Calcitonin screening demonstrates an acceptable PPV for diagnosing medullary thyroid cancer in patients with thyroid nodules.
- Routine calcitonin screening is recommended in centers specializing in thyroid disorders.
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