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Calcitonin as Biomarker for the Medullary Thyroid Carcinoma

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Medullary Thyroid Carcinoma

Part of the book series: Recent Results in Cancer Research ((RECENTCANCER,volume 204))

Abstract

Calcitonin (CTN) is a polypeptide hormone consisting of 32 amino acids with a disulfide bridge between position 1 and 7 that is mainly produced by the C-cells of thyroid gland. The measurement of CTN concentrations in blood reflects C-cell activity and is performed in general by immunoassay methods. However, there are analytical, physiological, pharmacological, and pathological factors that can influence results of serum CTN values. Due to the influence of these factors, there is a high variability in assay-dependent cutoffs used to discriminate between MTC, C-cell hyperplasia (CCH), and the absence of the pathological impairment of C-cells. There is a lot of evidence that the measurement of serum CTN concentrations in patients with thyroid nodules can lead to an earlier diagnosis of MTC or CCH than the exclusive use of imaging procedures and/or fine-needle aspiration cytology. Basal CTN concentrations higher than 60–100 pg/mL are highly indicative for the diagnosis MTC. In the range between cutoff and 60 pg/mL CTN, both MTC and HCC may be a relevant diagnosis. PCT and CTN appear to have a comparable diagnostic capability to diagnose MTCs. However, “positive” PCT values of more than 50 pg/mL may be reached also in subclinical infections and will lead, therefore, to an overdiagnosis of the tumor. Pentagastrin- or calcium-stimulated serum CTN concentrations higher than cutoff values might improve diagnostics of MTC, but the non-availability of the first and the lacking of relevant cutoff values for the second tool favors the use of only basal values currently.

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Abbreviations

AUC:

Area under the curve

CTN :

Calcitonin

CGRP:

Calcitonin gene-related peptide

1,25–OH–Vitamin D3:

Calcitriol

Ca:

Calcium

CCH:

C-cell hyperplasia

CKD:

Chronic kidney disease

CV:

Coefficients of variation

FNAC:

Fine-needle aspiration cytology

H2RB:

Histamine-2 receptor blockers

IRMA:

Immunoradiometric assay

MTC :

Medullary thyroid carcinoma

mRNA:

Messenger ribonucleic acid

NID:

Nichols Institute Diagnostics

PCTN :

Procalcitonin

PG:

Pentagastrin

PPV:

Positive predictive value

PPI:

Proton pump inhibitor

RIA:

Radioimmunoassay

ROC:

Receiver operating curve

RfB:

Reference Institute for Bioanalytics

WHO:

World Health Organization

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Bae, Y.J., Schaab, M., Kratzsch, J. (2015). Calcitonin as Biomarker for the Medullary Thyroid Carcinoma. In: Raue, F. (eds) Medullary Thyroid Carcinoma. Recent Results in Cancer Research, vol 204. Springer, Cham. https://doi.org/10.1007/978-3-319-22542-5_5

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