P394 - ECE_3872 - The role of the calcium stimulation test in the early detection of medullary thyroid carcinoma
Bildiriler > Özet Bildiri
Yazarlar: Selin Celik, Aykut Celik, Tugba Matlim Ozel, Zeynep Elüstü Belten, Ozge Sahin Kimyon, Utku Erdem Soyaltin, Sema Ciftci, Hamide Piskinpasa
European Journal of Endocrinology, , , Uluslararası, Özet Bildiri, Wos, cilt 195
DOI: 10.1093/ejendo/lvag096.527
Özet
Abstract Background Medullary thyroid carcinoma (MTC) is a malignancy originating from parafollicular-C cells and characterized by calcitonin (CT) secretion. Although basal calcitonin(bCT) levels have high sensitivity, mildly elevated CT levels may lead to diagnostic uncertainty. Since CT secreted by C cells is expected to rise in response to calcium stimulation, we aimed to assess the diagnostic value of the calcium stimulation test in patients with mildly CT levels who underwent surgery. Methods Forty-two patients with nodular thyroid disease and mildly elevated serum CT levels who underwent thyroidectomy were included in this study. None of the patients had any chronic disease known to cause elevated calcitonin. bCT and calcium-stimulated CT(casCT) levels were measured preoperative in all patients. CT reference values were considered positive at >6.4pg/mL for women and >9.5pg/mL for men. Given the known sex-releated differences in CT reference values, bCT and casCT levels were normalized by calculating the fold increase compared to the upper limit of normal(ULN). bCT and casCT levels were evaluated in relation to postoperative pathology for assessing diagnostic value. Results Among the 42 patients (19F/23M) with a mean age of 48 ± 12 years included in the study, MTC was diagnosed in 23.8% (6F/4M), while 76.2% (13F/19M) had non-MTC pathology. There were no significant differences between the groups in terms of age, sex, autoimmune thyroid disease, smoking or ppı use(P > .05). Median bCT levels were significantly higher in the MTC group (20pg/mL;range 11-98) than non-MTC group (13pg/mL; range 9-57)(P = .048). Similarly, the fold increase in bCT relative to the reference value was significantly higher in patients with MTC(2.75-fold;range 1.19-15.31) compared with the non-MTC group (1.57-fold;range 1.05-8.91)(P = .045). Median casCT levels were significantly higher in the MTC group (631.5pg/mL;range 164-1820) than non-MTC group(213pg/mL;range 31-855)(P = .020). The fold increase in casCT relative to the reference value was also significantly higher in patients with MTC (66.33-fold;range 25.63-284.38)compared with the non-MTC group(29.24-fold;range 4.84-97.66)(P = .017). ROC analysis showed that casCT cut-off of 37.4×ULN provided 70% sensitivity and 66% specificity for MTC diagnosis (AUC = 0.748, 95% Cl:0.582-0.915;P = .019). Conclusions Both bCT and casCT levels, as well as their fold increases relative to reference values, are significantly higher in patients with MTC. CasCT, particularly when expressed as multiples of the ULN, provides additional diagnostic value in patients with mildly elevated CT levels. A casCT cutoff of 37.4×ULN offers an acceptable balance between sensitivity and specificity for identifying MTC, although validation in larger prospective studies is warranted.