Impact of Routine Measurement of Serum Calcitonin on the Diagnosis and Outcome of Medullary Thyroid Cancer: Experience in 10,864 Patients with Nodular Thyroid Disorders
Rossella Elisei,
Valeria Bottici,
Fabiana Luchetti,
Giancarlo Di Coscio,
Cristina Romei,
Lucia Grasso,
Paolo Miccoli,
Pietro Iacconi,
Fulvio Basolo,
Aldo Pinchera and
Furio Pacini
Departments of Endocrinology and Metabolism (R.E., V.B., F.L., C.R., L.G., A.P.), Oncology (G.D.C., F.B.), and Surgery (P.M., P.I.), University of Pisa, 56124 Pisa, Italy; and Section of Endocrinology, Department of Internal Medicine, Endocrinology and Metabolism, and Biochemistry, University of Siena (F.P.), 53100 Siena, Italy
Address all correspondence and requests for reprints to: R. Elisei, M.D., Department of Endocrinology, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy. E-mail: relisei{at}endoc.med.unipi.it.
The survival rate of patients with medullary thyroid carcinoma(MTC) is significantly better in patients diagnosed and treatedwhen the tumor is limited to the thyroid. In a pioneer studycarried out in 1991, we demonstrated that routine measurementof serum calcitonin (CT) in nodular thyroid disease allowedthe preoperative diagnosis of unsuspected sporadic MTC withbetter accuracy than routine fine needle aspiration cytology(FNAC). This finding has been confirmed in subsequent studies.In the present study we report the results of CT screening in10,864 patients with thyroid nodular disease seen in the years1991–1998 (group 1). We analyzed the prevalence of MTCand compared their outcomes with those of a historical groupof patients (group 2) diagnosed before the introduction of CTscreening (1970–1990). The prevalence of MTC found byCT screening in group 1 was 0.40% (44 patients). A positiveCT test had a higher diagnostic sensitivity and specificitycompared with FNAC. CT screening allowed the diagnosis of MTCat an earlier stage compared with group 2 (P = 0.004). Normalizationof serum CT levels (undetectable) after surgery was more frequentlyobserved in group 1. At the end of follow-up, complete remissionwas observed in 59% of group 1 and in 2.7% of group 2 (P = 0.0001).Our study confirms that MTC is not an infrequent finding amongpatients with thyroid nodules (nearly 1 in 250 patients). Inaddition, screening thyroid nodules with serum CT measurementallows the diagnosis and treatment of MTC at an earlier stage,resulting in a better outcome compared with MTC not detectedby serum CT measurement. One of the reasons for this findingis that increasing the preoperative diagnostic accuracy of MTCprompts the surgeon to perform a more radical and possibly curativetreatment. On this basis, routine measurement of basal serumCT levels should be considered an integral part of the diagnosticevaluation of thyroid nodules.
This work was supported in part by grants from European Communities:INCO-Copernicus Project (IC15-CT980314), Ministero Italianodella Ricerca Scientifica e Tecnologica (ex 40%) 2000, and AssociazioneItaliana per la Ricerca sul Cancro.
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