比较降钙素和降钙素原在检测甲状腺结节患者甲状腺髓样癌中的价值。
Comparison of serum calcitonin and procalcitonin in detecting medullary thyroid carcinoma among patients with thyroid nodules.
机构信息
Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Via Ospedale 12, 6500 Bellinzona, Switzerland.
出版信息
Clin Chem Lab Med. 2013 Jul;51(7):1477-81. doi: 10.1515/cclm-2012-0610.
BACKGROUND
To prospectively evaluate the role of procalcitonin (PCT) in detecting or excluding medullary thyroid carcinoma (MTC) among patients with thyroid nodules and increased calcitonin (CT) levels.
METHODS
Fourteen of 1236 patients referred for thyroid nodules had increased serum CT >10 pg/mL. A stimulation test with pentagastrin was done and both CT and PCT were measured after stimulation. All patients underwent thyroid ultrasound, fine-needle cytology and, if indicated, surgery with histological and immunohistochemical examination of the surgical specimens.
RESULTS
After follow-up, two MTCs were found. These two patients had basal CT >100 pg/mL and detectable (>0.1 ng/mL) PCT, with 100% sensitivity. Pentagastrin stimulated CT achieved values above 100 pg/mL in two MTCs and in other two cases with no MTC outcome (50% PPV and 83% NPV). On the contrary, all patients with no MTC had both basal and stimulated undetectable PCT (100% PPV and 100% NPV).
CONCLUSIONS
The addition of basal PCT measurement in patients with thyroid nodule(s) and increased CT may significantly improve accuracy of CT measurement without needing a PG stimulation test.
背景
前瞻性评估降钙素原 (PCT) 在检测或排除伴有降钙素 (CT) 水平升高的甲状腺结节患者的髓样甲状腺癌 (MTC) 中的作用。
方法
在 1236 名因甲状腺结节就诊的患者中，有 14 名患者的血清 CT 升高 >10 pg/mL。进行五肽胃泌素刺激试验，在刺激后测量 CT 和 PCT。所有患者均接受甲状腺超声、细针细胞学检查，如果有必要，还进行手术，并对手术标本进行组织学和免疫组织化学检查。
结果
随访后发现 2 例 MTC。这 2 例患者的基础 CT >100 pg/mL，且可检测到 (>0.1 ng/mL) 的 PCT，敏感性为 100%。五肽胃泌素刺激 CT 在 2 例 MTC 和另外 2 例无 MTC 结局的患者中达到 >100 pg/mL（50% 的阳性预测值和 83% 的阴性预测值）。相反，所有无 MTC 的患者的基础和刺激后 PCT 均无法检测到（100% 的阳性预测值和 100% 的阴性预测值）。
结论
在伴有 CT 升高的甲状腺结节患者中增加基础 PCT 测量可显著提高 CT 测量的准确性，而无需进行 PG 刺激试验。
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