Detektion okkulter medullärer Schilddrüsenkarzinome bei Patienten eineruniversitären Schilddrüsen-Ambulanz: Diagnostischer Wert von Calcitonin-Screening, Pentagastrintest und Gastrinrezeptorszintigraphie
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Philipps-Universität Marburg
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Abstract
In patients with medullary thyroid carcinoma or neoplastic c-cell hyperplasia
extremely elevated basal calcitonin levels are known. The aim of this study was
to analyze the value of a basal calcitonin screening for early diagnosis of
medullary thyroid carcinoma or neoplastic c-cell hyperplasia in a large
population of clinically inconspicuous individuals. The diagnostic value of
elevated calcitonin levels after Pentagastrin stimulation test, the use of
preoperative diagnostic ultrasound, and CCK-2-receptor scintigraphy with
111Indium-D-Glu1-sulfated Minigastrin in terms of predictive values were also
evaluated. Additionally the correlation between the pathologic tracer
enhancement, the calcitonin levels and the final histological diagnosis was
analysed. In conclusion we re-evaluated our current diagnostic algorithm.
A total of 4858 patients over a period of 47 months were reviewed. All of them
underwent testing of basal calcitonin level in serum blood and were clinically
examined in the thyroid ambulance of a medicine university hospital. 300
patients off all had increased calcitonin levels considering normal cut off values
< 4,6 pg/ml in women and < 11,5 pg/ml in men. 259 of them underwent a
stimulation test with Pentagastrin. 1,1% of these patients had also elevated
stimulated calcitonin levels >100,0 pg/ml. Patients having stimulated calcitonin
levels less than 100,0 pg/ml were advised to control the calcitonin level once a
year. 34 of 55 patients with suspicious calcitonin levels and prior to
thyroidectomy had additional CCK-2 receptor scintigraphy with 111Indium-D-Glu1
sulfated Minigastrin. Finally 32 patients underwent surgery whereof two had a
medullary thyroid carcinoma. The prevalence to suffer from medullary thyroid
carcinoma in this population was 0,04%. Both patients with medullary thyroid
carcinoma had an advanced basal and the stimulated calcitonin level compared
with patients with c-cell hyperplasia or a thyroid without pathological findings.
For differential diagnosis of thyroid carcinoma, neoplastic, nodulary or diffuse ccell
hyperplasia or an inconspicuous thyroid the calcitonin test (basal and
stimulated) by itself can not be used.
104
On the basis of the results of the present study it is very important using a
diagnostic cascade. First basal calcitonin level should be checked in blood
serum. In case of extensive values (dependance on used assay), a stimulation
test with Pentagastrin should be added. Only a stimulated value >100,0 pg/ml
presumes the existence of a medullary thyroid carcinoma or a neoplastic c-cell
hyperplasia. The extreme value of stimulated calcitonin of 100,0 pg/ml appears
to be correct, because after thyroidectomy we detected more pathological
thyroids (CA, nodulary-, diffuse C-cell hyperplasie), than thyroids without
pathological findings. Indication for thyroidectomy in these patients is only seen
in pathologically elevated calcitonin levels after stimulation.
Scintigraphy with 111Indium-D-Glu1 sulfated Minigastrin is inadequate for primary
diagnosis of medullary thyroid carcinoma. The more it is important in
postoperative clinical monitoring, detecting recurrent disease or metastases, or
in cases of persistent increased calcitonin levels.
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Dates
Created: 2010Issued: 2010-08-02Updated: 2011-08-10
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
Pentagastrintestscreeningpentagastrintestmedullary thyroid carcinomaCalcitonin
DFG-subjects
Medullärer SchilddrüsenkrebsCalcitoninFrühdiagnostik
DDC-Numbers
610
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Voigt, Kathrin (113504861): Detektion okkulter medullärer Schilddrüsenkarzinome bei Patienten eineruniversitären Schilddrüsen-Ambulanz: Diagnostischer Wert von Calcitonin-Screening, Pentagastrintest und Gastrinrezeptorszintigraphie. : Philipps-Universität Marburg 2010-08-02. DOI: https://doi.org/10.17192/z2010.0391.
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This item has been published with the following license: In Copyright