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Calculation and validation of a plasma calcitonin limit for early detection of medullary thyroid carcinoma in nodular thyroid disease
Thyroid, 04/17/09

Rink T et al. - In a study to determine an upper plasma calcitonin concentration (pCT-C) to distinguish pts with and without medullary thyroid carcinoma (MTC) in a collective with nodular thyroid disease, and to estimate the prevalence of MTC in an endemic goiter area, it was found that an upper limit of 15 ng/L instead of 10 ng/L for basal pCT-C is able to detect all MTC and reduce false-positive cases. Prevalence of MTC in nodular thyroid disease in this group was approximately 1.8 per thousand.

Methods

Basal pCT-C was measured in 21,928 pts with thyroid nodules living in central Germany, an area with endemic goiter due to previous iodine deficiency.
In 218 subjects with pCT-Cs exceeding 10 ng/L, stimulated pCT-C was additionally determined.
A nominal normal range for basal pCT-C was calculated with data from 21,900 subjects without known MTC.
Predicted upper limit was validated using known diagnoses of 376 pts with pCT-Cs exceeding 10 ng/L, 28 of whom presented with MTC.

Results

For basal pCT-C, calculation of 3-sigma borders after logarithmic transformation revealed upper limits of the nominal normal range of 14.6 ng/L in females and 32.8 ng/L in males, respectively.
3 male pts with small MTCs had basal pCT-Cs between 15 and 33 ng/L.
None of the pts with MTC had a basal pCT-C below 15 ng/L or an increase in pCT-C after pentagastrin stimulation that was <80 ng/L.
In the basal pCT-C range between 15 and 50 ng/L (n=192; 8 with MTC), positive predictive value for detection of MTC was 4%.
Applying an upper limit for basal pCT-C of 15 ng/L in both sexes, 329 of 21,928 pts exceeded this range.
Among these, final outcome is known in 231 subjects, including all 28 MTCs.

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