EP82 – A cut-off value of basal serum calcitonin for detecting metastatic medullary thyroid carcinoma

      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.   References:
    1. C. De Crea, M. Raffaelli, V. Milano, C. Carrozza, C. Zuppi, R. Bellantone, C. P. Lombardi. Intraoperative high-dose calcium stimulation test in patients with sporadic medullary thyroid carcinoma is highly accurate in predicting lateral neck metastases. Surgery. 2016 Jan;159(1):70-6.
    2. G. Lupone, A. Antonino, A. Rosato, P. Zenone, E. M. Iervolino, M. Grillo, M. De Palma. Surgical strategy for the treatment of sporadic medullary thyroid carcinoma: our experience. G Chir. 2012 Nov-Dec;33(11-12):395-9.
    3. A. Machens, R. Hinze, O. Thomusch, H. Dralle. Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg. 2002 Jan;26(1):22-8.
    4. A. Machens, K. Lorenz, H. Dralle. Utility of serum procalcitonin for screening and risk stratification of medullary thyroid cancer. J Clin Endocrinol Metab. 2014 Aug;99(8):2986-94.


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