Caterina Mian1, Michela Perrino, Carla Colombo, Elisabetta Cavedon, Gianmaria Pennelli, Stefano Ferrero, Simone De Leo, Cristiano Sarais, Chiara Cacciatore, Gloria Irene Manfredi, Uberta Verga, Maurizio Iacobone, Loredana De Pasquale, Maria Rosa Pelizzo, Leonardo Vicentini, Luca Persani, Laura Fugazzola. 1. Endocrinology (C.M., E.C.) and Surgical Pathology and Cytopathology (G.P.) Units, Department of Medicine; Minimally Invasive Endocrine Surgery Unit (M.I.), Department of Surgery, Oncology, and Gastroenterology; and Departments of Cardiologic, Thoracic, and Vascular Sciences (C.S.) and Surgery, Oncology, and Gastroenterology (M.R.P.), University of Padua, 35122 Padua, Italy; Departments of Clinical Sciences and Community Health (M.P., C.Co., S.D.L., U.V., L.F., C.Ca., G.I.M., L.P.) and Biomedical, Surgical, and Dental Sciences (S.F.), University of Milan, and Endocrine (M.P., C.Co., S.D.L., U.V., L.F.), Division of Pathology (S.F.), and Endocrine Surgery (L.V.) Units, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda, 20122 Milan, Italy; Division of Endocrine and Metabolic Diseases (C.Ca., G.I.M., L.P.), Ospedale San Luca, IRCCS Istituto Auxologico Italiano, 20149 Milan; and Endocrine Surgery Unit (L.D.P.), San Paolo Hospital, 20142 Milan, Italy.
Abstract
CONTEXT: Calcitonin (CT) measurement is crucial to the early diagnosis and the follow-up of medullary thyroid cancer (MTC). If the evaluation of stimulated CT levels is required, a provocative test can be performed, being the high-dose Ca test recently reintroduced in clinical practice. OBJECTIVE: Our objective was to identify gender-specific thresholds for MTC diagnosis in a large series of patients who underwent the Ca test. PATIENTS AND METHODS: A total of 91 patients (49 females and 42 males) underwent the Ca test (calcium gluconate, 25 mg/kg) before thyroidectomy and both basal CT (bCT) and stimulated CT (sCT) were compared with histological results by receiver operating characteristic plot analyses. To evaluate possible side effects of Ca administration, cardiac function has been extensively studied. RESULTS: bCT levels were found to harbor the same accuracy as sCT in the preoperative diagnosis of MTC. The best Ca thresholds for the identification of MTC were >26 and >68 for bCT and >79 and >544 pg/mL for sCT in females and males, respectively. The high tolerability and safety of the Ca test was demonstrated and advice offered to be followed before and during the test. CONCLUSIONS: Gender-specific bCT and sCT cutoffs for the identification of C-cell hyperplasia and/or MTC have been defined. The bCT and sCT were found to have a similar accuracy, indicating that serum CT assays with improved functional sensitivity may likely decrease the relevance of the stimulation test in several conditions. Finally, systematic cardiac monitoring confirms the safety of the Ca test.
CONTEXT: Calcitonin (CT) measurement is crucial to the early diagnosis and the follow-up of medullary thyroid cancer (MTC). If the evaluation of stimulated CT levels is required, a provocative test can be performed, being the high-dose Ca test recently reintroduced in clinical practice. OBJECTIVE: Our objective was to identify gender-specific thresholds for MTC diagnosis in a large series of patients who underwent the Ca test. PATIENTS AND METHODS: A total of 91 patients (49 females and 42 males) underwent the Ca test (calcium gluconate, 25 mg/kg) before thyroidectomy and both basal CT (bCT) and stimulated CT (sCT) were compared with histological results by receiver operating characteristic plot analyses. To evaluate possible side effects of Ca administration, cardiac function has been extensively studied. RESULTS: bCT levels were found to harbor the same accuracy as sCT in the preoperative diagnosis of MTC. The best Ca thresholds for the identification of MTC were >26 and >68 for bCT and >79 and >544 pg/mL for sCT in females and males, respectively. The high tolerability and safety of the Ca test was demonstrated and advice offered to be followed before and during the test. CONCLUSIONS: Gender-specific bCT and sCT cutoffs for the identification of C-cell hyperplasia and/or MTC have been defined. The bCT and sCT were found to have a similar accuracy, indicating that serum CT assays with improved functional sensitivity may likely decrease the relevance of the stimulation test in several conditions. Finally, systematic cardiac monitoring confirms the safety of the Ca test.
Authors: Samuel A Wells; Sylvia L Asa; Henning Dralle; Rossella Elisei; Douglas B Evans; Robert F Gagel; Nancy Lee; Andreas Machens; Jeffrey F Moley; Furio Pacini; Friedhelm Raue; Karin Frank-Raue; Bruce Robinson; M Sara Rosenthal; Massimo Santoro; Martin Schlumberger; Manisha Shah; Steven G Waguespack Journal: Thyroid Date: 2015-06 Impact factor: 6.568
Authors: Hans Hg Verbeek; Jan Willem B de Groot; Wim J Sluiter; Anneke C Muller Kobold; Edwin R van den Heuvel; John Tm Plukker; Thera P Links Journal: Cochrane Database Syst Rev Date: 2020-03-16
Authors: Detlef K Bartsch; Markus Luster; Heinz J Buhr; Dietmar Lorenz; Christoph-Thomas Germer; Peter E Goretzki Journal: Dtsch Arztebl Int Date: 2018-01-08 Impact factor: 5.594