ECE2006 Poster Presentations Thyroid (174 abstracts)
Value of routine measurement of serum calcitonin concentrations in patients with nodular goiter: a multicenter study
G Papi 1 , SM Corsello 2 , K Cioni 1 , AM Pizzini 3 , S Corrado 4 , C Carapezzi 3 , G Fadda 5 , A Baldini 3 , C Carani 1 , A Pontecorvi 2 & E Roti 6
1University of Modena and Reggio Emilia, Department of Internal Medicine, Chair of Endocrinology, Modena, Italy; 2Catholic University of Rome, Department of Internal Medicine, Chair of Endocrinology, Rome, Italy; 3AUSL Modena, Department of Internal Medicine, Modena, Italy; 4University of Modena and Reggio Emilia, Department of Forensic and Morphologic Sciences, Section of Pathology, Modena, Italy; 5Catholic University of Rome, Section of Pathology, Rome, Italy; 6University of Milan, Institute of Endocrinology, Milan, Italy.
Context. The routine measurement of serum calcitonin (CT) has been proposed for patients with nodular goiter (NG), to detect unsuspected medullary thyroid carcinoma (MTC) before surgery. Objective To assess the prevalence of hypercalcitoninemia and MTC in NG patients; to compare the ability of CT measurement and fine needle aspiration cytology (FNAC) to predict MTC; to identify age groups of NG patients who should be better candidates than others to undergo routine measurement of CT. Design, Setting and Patients 1425 consecutive patients with NG, referred to 4 Italian endocrine centers due to NG, were grouped depending on age, and underwent basal and, in some cases, Pentagastrin (Pg)-stimulated CT measurement, FNAC and, when indicated, surgery. Serum CT concentrations were measured by an immunoluminometric assay (ILMA). Results Hypercalcitoninemia was found in 23 of 1425 patients. MTC was discovered in 9 patients, all belonging to age groups 2–4 and showing high CT levels. Sensitivity of basal and Pg-stimulated CT to predict MTC before surgery was 100% for both tests, whereas specificity was 95% and 93%, respectively. FNAC showed an overall 86% sensitivity. When >10 mm MTC nodules were considered, FNAC sensitivity approached 100%. On the contrary, a correct cytological diagnosis was obtained in only 1/5 patients with <10 mm MTC nodules (microMTC); in 1 patient with histologically proved microMTC, FNAC demonstrated a benign lesion. Hypercalcitoninemia or MTC were associated with chronic thyroiditis in 30% or 33% of cases, respectively. C-cell hyperplasia was found in 57% of hypercalcitoninemic patients without MTC. Conclusions Basal CT measurement detects elevated CT values in 1.6% of NG patients. Although CT is not a specific marker of MTC, its routine measurement represents a useful tool in the pre-operative evaluation of NG patients, particularly those older than 40 years presenting with nodules smaller than 10 mm, even when FNAC does not show malignant features. To our knowledge, this is the first trial using ILMA to assess the ability of pre-operative CT measurement to predict MTC in a large series of NG patients.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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