Abstract
Medullary thyroid carcinoma (MTC) is caused by a malignant transformation in the parafollicular C-cells of the thyroid, where calcitonin (CT) is released. Nowadays, CT is the main tumor marker used in the diagnosis and follow-up of MTC patients. Nonetheless, procalcitonin (PCT) has recently been proposed as a useful complementary/alternative biomarker in MTC. Our aims were to investigate the diagnostic performance of CT and PCT and their combination in the differential diagnosis between active and inactive MTC and between MTC and non-MTC thyroid diseases, respectively. Serum samples were collected from 16 patients with active (i.e. primary tumour before surgery or post-surgical recurrent disease) and 23 with inactive (i.e. complete remission) MTC, 125 patients with non-MTC benign thyroid disease and 62 patients with non-MTC thyroid cancers, respectively. Elecsys® CT and PCT measurements were simultaneously performed on the Cobas e601 platform (Roche Diagnostics, Rotkreutz, Switzerland). Both CT and PCT median values in active MTC (94pmol/L and 1.17ng/mL, respectively) were significantly higher compared with inactive MTC (0.28 and 0.06) and either benign (0.37 and 0.06) or malignant (0.28 and 0.06) non-MTC. Undetectable PCT was found in five non-MTC patients with false positive CT results. Elecsys® PCT assay is a highly sensitive and specific alternative MTC marker. At the very least it appears useful in patients with positive CT results as negative PCT values securely exclude active MTC. The availability of both markers on the same automated platform facilitates reflex or reflective strategies to refine the laboratory diagnosis.
Highlights
Medullary thyroid carcinoma (MTC) is a malignant tumor of the thyroid cells C cells, accounting for about 2–5% of thyroid cancers [1]
Undetectable PCT was found in five non-MTC patients with false positive CT results
This retrospective study evaluated the use of Elecsys® CT and PCT as tumor markers in patients with MTC
Summary
Medullary thyroid carcinoma (MTC) is a malignant tumor of the thyroid cells C cells, accounting for about 2–5% of thyroid cancers [1]. Calcitonin (CT), the main C cell secretory product, is considered a sensitive and specific marker for the diagnosis and follow-up of MTC [2]. CT assays suffer pre-analytic and analytic drawbacks: i. The presence of various different immunoreactive isoforms and fragments, which can lead to inaccurate results (usually false low) as well as poor comparability of results obtained by different assays [4,5,6,7]. Administrating intravenous calcium or pentagastrin was largely used to improve the accuracy of CT measurement; specificity is suboptimal and establishing clear reference guidelines for abnormal stimulated serum CT levels is a much more challenging task than establishing reference guidelines for abnormal basal CT levels.
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