Circulating Biomarkers in Medullary Thyroid Carcinoma: Bridging Laboratory Complexities and Clinical Application...

Area of Science:

• Endocrinology
• Oncology
• Biomarker Discovery

Background:

• Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor originating from C-cells.
• Accurate diagnosis, staging, and surveillance depend heavily on circulating biomarkers.
• Current management strategies require optimization through advanced biomarker utilization.

Purpose of the Study:

• To provide a comprehensive overview of circulating biomarkers in MTC management.
• To propose an integrated, evidence-based algorithm for clinical decision-making.
• To emphasize analytical advancements and clinical applications of biomarkers.

Main Methods:

• Narrative review of established and emerging circulating biomarkers for MTC.
• Analysis of analytical advancements, clinical applications, and prognostic implications.
• Integration of biomarkers into a clinical decision-making framework.

Main Results:

• Calcitonin remains a cornerstone biomarker, with improved assays addressing analytical challenges.
• Procalcitonin (ProCT) offers a stable alternative or adjunct, especially for indeterminate calcitonin levels.
• Carcinoembryonic antigen (CEA) is a complementary marker for aggressive disease; kinetic evaluation of calcitonin and CEA provides prognostic insights.
• Emerging biomarkers like pro-gastrin-releasing peptide (ProGRP) and CA19-9 show promise in monitoring advanced disease and treatment response.

Conclusions:

• An integrated biomarker approach enhances diagnostic precision and prognostic stratification in MTC.
• Newer biomarkers, alongside calcitonin and CEA, facilitate personalized follow-up and treatment strategies.
• Evidence-based algorithms incorporating established and emerging biomarkers are crucial for optimal MTC management.