EYES2024 ESE Young Endocrinologists and Scientists (EYES) 2024 Thyroid (12 abstracts)
Challenging reference values for basal and stimulated calcitonin in medullary thyroid cancer diagnosis: a 2 center experience from real life setting
Salvatore Ariano 1 , Sara Bodini 3 , Walter Vena 1,2 , Rosa Miranda Testa 1 , Valentina Villa 1 , Paolo Colombo 3 , Antonio Bossi 1 , Gherardo Mazziotti 2,3 & Andrea Gerardo Lania 2,3
1Endocrinology & Diabetes Center, Humanitas Gavazzeni Institute, Bergamo, Italy; 2Humanitas University, Department of Biomedical Sciences, Pieve Emanuele (MI), Italy; 3IRCCS Humanitas Research Hospital, Endocrinology, Diabetology and Medical Andrology Unit, Rozzano (MI)
Introduction: Measurement of basal (bCT) and stimulated calcitonin (sCT) after calcium gluconate infusion can help detect early-stage medullary thyroid cancer (MTC). However there are no standardized cutoffs to discriminate between MTC and other thyroid conditions including c-cell hyperplasia.
Methods: A retrospective analysis was conducted on 62 consecutive calcium gluconate stimulation tests performed in 2 Italian institutions from 2015 to 2024. Patients with known RET mutations were excluded. Basal and stimulated calcitonin were measured with LIAISON-Calcitonin-IIGen assay (DIASORIN). Patients were retrospectively categorized according to commonly used, nationally validated cutoffs: bCT >30 pg/ml and sCT >79 pg/ml for females, bCT >34 pg/ml and sCT >466 pg/ml for males.
Results: Of the 62 patients enrolled, 67% females (22/33) and 24% males (7/29) underwent thyroidectomy. Mean bCT and sCT levels were 48.1 pg/ml and 765.6 pg/ml in MTC, compared to 15.6 pg/ml, 282.9 pg/ml in non-MTC patients. Concordant positive bCT and sCT predicted MTC in 80% of cases. Increased sCT alone resulted in 84% false positives (16/19), predominantly in females. One MTC patient was missed by both bCT and sCT cutoffs. In women, bCT >30 pg/ml had 67% sensitivity and 100% specificity for MTC detection. sCT >79 pg/ml had 100% sensitivity but only 6% specificity. In our series an alternative cutoff of sCT >257 pg/ml could provide 100% sensitivity and 81% specificity. Surgical complications included permanent hypoparathyroidism (41%) and dysphonia (7%). Prophylactic central neck dissection was performed in 66% of cases, leading to higher rates of permanent hypoparathyroidism (53% vs 10%).
Conclusion: Routine calcitonin measurement and calcium gluconate testing can identify preclinical MTC, but carry significant risks of false positives, leading to unnecessary surgery, with relevant morbidity. Given the discordance of literature data, calcium gluconate testing should rely on institution-specific cutoffs. If unavailable, it should be delayed favoring trend monitoring for low bCT values.
Article tools
My recent searches
My recently viewed abstracts
Authors
Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more