open access
Diagnostic value of selected biochemical markers in the detection of recurrence of medullary thyroid cancer — comparison of calcitonin, procalcitonin, chromogranin A, and carcinoembryonic antigen
Affiliations- Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Sciences, Poland
open access
Abstract
Introduction: Medullary thyroid cancer (MTC) is a malignancy of the thyroid gland, which derives from parafollicular C cells. Periodic measurement of biochemical markers of MTC remains a crucial part of patient follow-up and disease monitoring. The aim of the study was to compare the diagnostic value of four selected markers — calcitonin (Ct), procalcitonin (PCT), chromogranin A (CgA), and carcinoembryonic antigen (CEA).
Material and methods: Patients with histopathologically confirmed MTC hospitalised in a single department between January 2015 and December 2015 were included in the study. Patients were subdivided into two groups: a remission group and an active disease group, based upon serum markers of MTC and imaging. Levels of Ct, PCT, CgA, and CEA were compared between the groups.
Results: Forty-four patients were included; 20 patients presented active disease and 24 were in remission. All patients with active disease had Ct exceeding the upper limit of normal range (10 pg/mL) — for that threshold the sensitivity was 100.0% and the specificity was 73.9%; for the best-fit threshold of 121.0 pg/mL the specificity was 95.8% with sensitivity 100.0%. There was significant correlation between Ct and PCT — p < 0.000001, r = 0.93. All patients with active disease exceeded the upper limit of the normal range (0.5 ng/mL) — for that threshold the sensitivity was 100.0% and the specificity was 83.3%; for the best-fit threshold of 0.95 ng/mL the specificity was 95.8% with sensitivity 100.0%. In case of CEA for the best-fit threshold of 12.66 ng/mL the specificity was 100.0% with sensitivity 57.9%; for CgA the best-fit threshold was 75.66 ng/mL with specificity 83.3% and sensitivity 75.0%.
Conclusions: Our study confirms that PCT can be considered as an equivalent alternative for measurement of calcitonin. On the other hand, it is also worth noting that MTC can be a rare cause of very high levels of PTC not resulting from infectious diseases. The diagnostic value of CEA and chromogranin A is much lower and can be within the normal range even in patients with advanced, metastatic MTC. They should be used only as accessory markers.
Abstract
Introduction: Medullary thyroid cancer (MTC) is a malignancy of the thyroid gland, which derives from parafollicular C cells. Periodic measurement of biochemical markers of MTC remains a crucial part of patient follow-up and disease monitoring. The aim of the study was to compare the diagnostic value of four selected markers — calcitonin (Ct), procalcitonin (PCT), chromogranin A (CgA), and carcinoembryonic antigen (CEA).
Material and methods: Patients with histopathologically confirmed MTC hospitalised in a single department between January 2015 and December 2015 were included in the study. Patients were subdivided into two groups: a remission group and an active disease group, based upon serum markers of MTC and imaging. Levels of Ct, PCT, CgA, and CEA were compared between the groups.
Results: Forty-four patients were included; 20 patients presented active disease and 24 were in remission. All patients with active disease had Ct exceeding the upper limit of normal range (10 pg/mL) — for that threshold the sensitivity was 100.0% and the specificity was 73.9%; for the best-fit threshold of 121.0 pg/mL the specificity was 95.8% with sensitivity 100.0%. There was significant correlation between Ct and PCT — p < 0.000001, r = 0.93. All patients with active disease exceeded the upper limit of the normal range (0.5 ng/mL) — for that threshold the sensitivity was 100.0% and the specificity was 83.3%; for the best-fit threshold of 0.95 ng/mL the specificity was 95.8% with sensitivity 100.0%. In case of CEA for the best-fit threshold of 12.66 ng/mL the specificity was 100.0% with sensitivity 57.9%; for CgA the best-fit threshold was 75.66 ng/mL with specificity 83.3% and sensitivity 75.0%.
Conclusions: Our study confirms that PCT can be considered as an equivalent alternative for measurement of calcitonin. On the other hand, it is also worth noting that MTC can be a rare cause of very high levels of PTC not resulting from infectious diseases. The diagnostic value of CEA and chromogranin A is much lower and can be within the normal range even in patients with advanced, metastatic MTC. They should be used only as accessory markers.
Keywords
procalcitonin, calcitonin, medullary thyroid cancer, chromogranin A, carcinoembryonic antigen
About this articleTitle
Diagnostic value of selected biochemical markers in the detection of recurrence of medullary thyroid cancer — comparison of calcitonin, procalcitonin, chromogranin A, and carcinoembryonic antigen
Journal
Issue
Article type
Original paper
Pages
434-437
Published online
2017-06-01
Page views
2148
Article views/downloads
1729
DOI
Pubmed
Bibliographic record
Endokrynol Pol 2017;68(4):434-437.
Keywords
procalcitonin
calcitonin
medullary thyroid cancer
chromogranin A
carcinoembryonic antigen
Authors
Kosma Woliński
Jarosław Kaznowski
Aleksandra Klimowicz
Adam Maciejewski
Dagny Łapińska-Cwojdzińska
Edyta Gurgul
Adrian D. Car
Marta Fichna
Paweł Gut
Maria Gryczyńska
Marek Ruchała
References (22)- Krysiak R, Marek B, Okopień B. [Medullary thyroid cancer - the present state of art]. Endokrynol Pol. 2008; 59(5): 446–455.
- Wells SA, Asa SL, Dralle H, et al. American Thyroid Association Guidelines Task Force on Medullary Thyroid Carcinoma. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015; 25(6): 567–610.
- Gimm O. Thyroid cancer. Cancer Letters. 2001; 163(2): 143–156.
- Favia G, Iacobone M. Medullary thyroid carcinoma: state of the art. G Chir. 2005; 26(11-12): 405–409.
- Rossi ED, Bizzarro T, Martini M, et al. The evaluation of miRNAs on thyroid FNAC: the promising role of miR-375 in follicular neoplasms. Endocrine. 2016; 54(3): 723–732.
- Woliński K, Rewaj-Łosyk M, Ruchała M. Sonographic features of medullary thyroid carcinomas--a systematic review and meta-analysis. Endokrynol Pol. 2014; 65(4): 314–318.
- Raue F, Frank-Raue K. Long-Term Follow-up in Medullary Thyroid Carcinoma. Medullary Thyroid Carcinoma. 2015: 207–225.
- Jarząb B, Dedecjus M, Handkiewicz-Junak D, et al. Diagnostyka i leczenie raka tarczycy. Endokrynologia Polska. 2016; 67(1): 74–145.
- Czepczyński R, Matysiak-Grześ M, Gryczyńska M, et al. Peptide receptor radionuclide therapy of differentiated thyroid cancer: efficacy and toxicity. Arch Immunol Ther Exp (Warsz). 2015; 63(2): 147–154.
- Kunikowska J, Ziemnicka K, Pawlak D, et al. Medullary thyroid carcinoma - PET/CT imaging with 68Ga-labelled gastrin and somatostatin analogues. Endokrynol Pol. 2016; 67(1): 68–71.
- Kaczka K, Mikosiński S, Fendler W, et al. Can procalcitonin be useful for medullary thyroid cancer? Endokrynol Pol. 2010; 61(5): 430–436.
- Kaczka K, Fendler W, Borowiec M, et al. One-step nucleic acid amplification testing in medullary thyroid cancer lymph nodes: a case series. Arch Med Sci. 2015; 11(1): 137–141.
- Davies J. Procalcitonin. Journal of Clinical Pathology. 2015; 68(9): 675–679.
- Trimboli P, Seregni E, Treglia G, et al. Procalcitonin for detecting medullary thyroid carcinoma: a systematic review. Endocr Relat Cancer. 2015; 22(3): R157–R164.
- Kaczka K, Mikosiński S, Fendler W, et al. Calcitonin and procalcitonin in patients with medullary thyroid cancer or bacterial infection. Adv Clin Exp Med. 2012; 21: 169–178.
- Plebani M, Fabbri LM. Procalcitonin-guided antibiotic therapy: a potentially effective and efficient strategy. Clin Chem Lab Med. 2015; 53(4): 519–520.
- Walter MA, Meier C, Radimerski T, et al. Procalcitonin levels predict clinical course and progression-free survival in patients with medullary thyroid cancer. Cancer. 2010; 116(1): 31–40.
- Bolko P, Manuszewska-Jopek E, Michałek K, et al. Efficacy of procalcitonin measurement in patients after total thyroidectomy due to medullary thyroid carcinoma Arch Immunol Ther Exp (Warsz. 2003; 51: 415–419.
- Kratzsch J, Petzold A, Raue F, et al. Basal and stimulated calcitonin and procalcitonin by various assays in patients with and without medullary thyroid cancer. Clin Chem. 2011; 57(3): 467–474.
- Algeciras-Schimnich A, Preissner CM, Theobald JP, et al. Procalcitonin: a marker for the diagnosis and follow-up of patients with medullary thyroid carcinoma. J Clin Endocrinol Metab. 2009; 94(3): 861–868.
- Louthan O, Louthan O. Chromogranin a in physiology and oncology. Folia Biol (Praha). 2011; 57(5): 173–181.
- Gut P, Czarnywojtek A, Fischbach J, et al. et al.. Arch Med Sci. 2016; 12: 1–9.
