Iacobone Maurizio, Niccoli-Sire Patricia, Sebag Frederic, De Micco Catherine, Henry Jean-François
Department of General and Endocrine Surgery, University Hospital La Timone, 264 Rue Saint Pierre, 13385 Marseilles, France.
World J Surg. 2002 Aug;26(8):886-90. doi: 10.1007/s00268-002-6613-0. Epub 2002 May 21.
Measuring serum calcitonin (CT) in patients with thyroid diseases allows preoperative diagnoses of sporadic medullary thyroid carcinoma (MTC) and C-cell hyperplasia (CCH). The aim of this prospective study was to distinguish biochemically between CCH and MTC. Basal CT (bCT) was determined in 7276 consecutive patients referred for thyroid disease. Patients with recurrent, persistent, or familial MTC were excluded. When bCT was > 10 pg/ml a pentagastrin-stimulated CT (sCT) assay was performed. Patients were routinely operated on when bCT > 30 pg/ml or sCT > 100 pg/ml or when other indications for surgery were present. An extensive search for CCH or microscopic MTC was conducted by immunochemistry. Pathologic findings were correlated with the bCT and sCT values. In this study 66 patients were included. No morphologic alterations of C-cells were observed in 5 patients; 16 patients presented with CCH and 45 with MTC. Statistical analysis revealed a correlation of sCT and overall bCT with tumor size and staging (p <0.001). Considering cutoff values for bCT of < or = 30 pg/ml and for sCT of < or = 200 pg/ml, the positive predictive value of the test to detect MTC was 100% and the negative predictive value 63%. No patients with MTC at stage 2 to 4 had bCT <30 pg/ml or sCT <200 pg/ml. A bCT value of < or = 30 pg/ml or sCT < or = 200 pg/ml (or both) is highly predictive of MTC, requiring total thyroidectomy with lymph node dissection. Values of bCT <30 pg/ml and sCT <200 pg/ml do not distinguish between CCH and MTC at stage 1. In this case total thyroidectomy at least is recommended, and the role of nodal dissection might be discussed.
检测甲状腺疾病患者的血清降钙素（CT）有助于术前诊断散发性甲状腺髓样癌（MTC）和C细胞增生（CCH）。这项前瞻性研究的目的是从生化角度区分CCH和MTC。对7276例因甲状腺疾病前来就诊的连续患者测定了基础CT（bCT）。排除复发性、持续性或家族性MTC患者。当bCT>10 pg/ml时，进行五肽胃泌素刺激CT（sCT）检测。当bCT>30 pg/ml或sCT>100 pg/ml或存在其他手术指征时，患者常规接受手术。通过免疫化学广泛查找CCH或微小MTC。将病理结果与bCT和sCT值进行关联。本研究纳入了66例患者。5例患者未观察到C细胞形态改变；16例患者表现为CCH，45例患者表现为MTC。统计分析显示sCT和总体bCT与肿瘤大小和分期相关（p<0.001）。考虑bCT≤30 pg/ml和sCT≤200 pg/ml的临界值，检测MTC的试验阳性预测值为100%，阴性预测值为63%。2至4期MTC患者中无bCT<30 pg/ml或sCT<200 pg/ml的情况。bCT值≤30 pg/ml或sCT≤200 pg/ml（或两者均有）高度提示MTC，需要行全甲状腺切除术加淋巴结清扫。bCT<30 pg/ml和sCT<200 pg/ml的值在1期时无法区分CCH和MTC。在这种情况下，至少建议行全甲状腺切除术，并且可能需要讨论淋巴结清扫的作用。
