Clinical performance of an extraction calcitonin radioimmunoassay

An extraction radioimmunoassay of calcitonin (CT) was used to replace the direct radioimmunoassay, in which false-negative results (normal basal CT values but above normal ["positive"] results after pentagastrin stimulation) occurred in 26 to 30% of cases. During the past 6 years, 170 pentagastrin stimulation tests were performed in 135 patients at our institution. We reviewed the results to determine whether extraction radioimmunoassay yielded improvement. Of the 135 patients, 6 (4.4%) had indeterminate results of pentagastrin stimulation tests that consisted of normal basal levels but increased values after pentagastrin stimulation, a considerable improvement over the results with direct assay. Six other patients had indeterminate results of pentagastrin testing--increased basal CT levels but normal values after pentagastrin stimulation. Indeterminate results of pentagastrin tests occurred primarily in postoperative or preoperative patients with a family history of medullary thyroid carcinoma (MTC). The reasons for the indeterminate results were unclear, as was their importance as a prelude to disease, but two preoperative patients with indeterminate results eventually had positive results and were found to have MTC at operation. We conclude that extraction radioimmunoassay is more reliable than direct radioimmunoassay for the diagnosis of MTC. Determination of a basal CT value and of the CT value after pentagastrin stimulation is sufficient for diagnosing MTC.