Makay, Özer1; Vatansever, Safa1; Ozdemir, Murat1; Icoz, Gokhan1; Akyildiz, Mahir1
1 Faculty of Medicine, Ege University, Izmir, Turkey
Aim: The aim was to identify cut-off levels for central and lateral lymph node metastasis in medullary thyroid cancer.
Methods: Forty-eight patients having MTC were enrolled retrospectively. Patients were assessed regarding demographics, preoperative serum calcitonin and carcinoembryonic antigen levels, familial / sporadic disease, incidental findings, tumour size, multifocality / multicentricity, vascular and capsular invasion, central / lateral lymph node metastasis, tumour stage, relapse / persistence and disease-free survival rate. Sensitivity and specificity of cut-off values of calcitonin related to lymph node metastasis were calculated.
Results: There were 26 women (54%) and 22 men (46%) and the mean age was 47 (19-84) years. Mean follow-up time was 54 months. In cases where central lymph node dissection had been carried out, 75% had metastasis. Lymph node metastasis was present in 75% of cases receiving central dissection and in 88% of those receiving lateral dissection. Using a cut-off basal CT value of 150 pg/ml, in patients exceeding this value, sensitivity and specificity were 95% and 55%, respectively for central node metastasis. Using a cut-off basal CT value of 222 pg/ml, in patients exceeding this value, sensitivity and specificity were 92% and 55%, respectively for lateral node metastasis. The risk of persistent disease illness increased in cases having both central and lateral cervical lymph node metastasis (p<0.05).
Conclusion: Serum basal CT can reflect the tumour burden of MTC. Identification of the optimal cut-off value of basal serum CT concentrations to distinguish non-metastatic MTC from metastatic conditions warrants more work-up.
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