Papi G, Corsello S M, Cioni K, Pizzini A M, Corrado S, Carapezzi C, Fadda G, Baldini A, Carani C, Pontecorvi A, Roti E
Department of Internal Medicine, University of Modena and Reggio Emilia, Modena, Italy.
J Endocrinol Invest. 2006 May;29(5):427-37. doi: 10.1007/BF03344126.
The routine measurement of serum calcitonin (CT) has been proposed for patients with nodular thyroid disease (NTD), to detect unsuspected medullary thyroid carcinoma (MTC) before surgery.
To assess the prevalence of hypercalcitoninemia and MTC in NTD patients; to compare the ability of CT measurement and fine needle aspiration cytology (FNAC) to predict MTC; to identify age groups of NTD patients who should be better candidates than others to undergo routine measurement of CT.
1425 consecutive patients, referred from April 1, 2003, through March 31, 2004, to four Italian endocrine centers due to NTD, 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).
Hypercalcitoninemia was found in 23 out of 1425 patients. MTC was discovered in 9 patients, all >40 yr old 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. CT specificity reached 100% when a cutoff value of 20 pg/ml was taken. 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 one out of five patients with <10 mm MTC nodules (microMTC); in one patient with histologically proved microMTC, FNAC even 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.
Basal CT measurement detects elevated CT values in 1.6% of NTD patients. Although CT is not a specific marker of MTC, its routine measurement represents a useful tool in the pre-operative evaluation of NTD patients, particularly those >40 yr old presenting with nodules <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 NTD patients.
有人提议对结节性甲状腺疾病（NTD）患者进行血清降钙素（CT）常规检测，以便在手术前发现未被怀疑的甲状腺髓样癌（MTC）。
评估NTD患者中高降钙素血症和MTC的患病率；比较CT检测和细针穿刺细胞学检查（FNAC）预测MTC的能力；确定NTD患者中哪些年龄组比其他年龄组更适合接受CT常规检测。
2003年4月1日至2004年3月31日期间，因NTD转诊至四个意大利内分泌中心的1425例连续患者，根据年龄分组，进行基础CT检测，部分患者进行五肽胃泌素（Pg）刺激后的CT检测、FNAC，并在必要时进行手术。血清CT浓度通过免疫发光测定法（ILMA）测量。
1425例患者中有23例发现高降钙素血症。9例患者被发现患有MTC，均年龄大于40岁且CT水平较高。基础CT和Pg刺激后CT在术前预测MTC的敏感性均为100%，而特异性分别为95%和93%。当临界值设定为20 pg/ml时，CT特异性达到100%。FNAC的总体敏感性为86%。当考虑MTC结节大于10 mm时，FNAC敏感性接近100%。相反，在5例MTC结节小于10 mm（微小MTC）的患者中，只有1例获得了正确的细胞学诊断；在1例组织学证实为微小MTC的患者中，FNAC甚至显示为良性病变。高降钙素血症或MTC分别在30%或33%的病例中与慢性甲状腺炎相关。在无MTC的高降钙素血症患者中，57%发现有C细胞增生。
基础CT检测在1.6%的NTD患者中检测到CT值升高。虽然CT不是MTC的特异性标志物，但对其进行常规检测是NTD患者术前评估的有用工具，特别是对于年龄大于40岁、结节小于10 mm的患者，即使FNAC未显示恶性特征。据我们所知，这是第一项使用ILMA评估术前CT检测在大量NTD患者中预测MTC能力的试验。
