دورية أكاديمية
أعرض في EDS

Calcitonin testing for detection of medullary thyroid cancer in people with thyroid nodules.

التفاصيل البيبلوغرافية
العنوان: Calcitonin testing for detection of medullary thyroid cancer in people with thyroid nodules.
المؤلفون: Verbeek HH; University of Groningen, University Medical Center Groningen, Department of Endocrinology, Hanzeplein 1, Groningen, Netherlands, 9713 GZ., de Groot JWB; Isala Oncological Center, Department of Internal Medicine, PO Box 10400, Zwolle, Netherlands, 8000 GK., Sluiter WJ; University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Hanzeplein 1, Groningen, Netherlands, 9700 RB., Muller Kobold AC; University of Groningen, University Medical Center Groningen, Laboratory Medicine, Hanzeplein 1, Groningen, Netherlands, 9700 RB., van den Heuvel ER; Eindhoven University of Technology, Department of Mathematics and Computer Science, P.O. Box 513, Eindhoven, Netherlands, 5600 MB., Plukker JT; University Medical Center Groningen, Onocological Surgery, Hanzeplein 1, Groningen, Netherlands, 9713 GZ., Links TP; University of Groningen, University Medical Center Groningen, Department of Endocrinology, Hanzeplein 1, Groningen, Netherlands, 9713 GZ.
المصدر: The Cochrane database of systematic reviews [Cochrane Database Syst Rev] 2020 Mar 16; Vol. 3. Cochrane AN: CD010159. Date of Electronic Publication: 2020 Mar 16.
نوع المنشور: Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Systematic Review
اللغة: English
بيانات الدورية: Publisher: Wiley Country of Publication: England NLM ID: 100909747 Publication Model: Electronic Cited Medium: Internet ISSN: 1469-493X (Electronic) Linking ISSN: 13616137 NLM ISO Abbreviation: Cochrane Database Syst Rev Subsets: MEDLINE
أسماء مطبوعة: Publication: 2004- : Chichester, West Sussex, England : Wiley
Original Publication: Oxford, U.K. ; Vista, CA : Update Software,
مواضيع طبية MeSH: Calcitonin/*blood , Carcinoma, Medullary/*blood , Carcinoma, Neuroendocrine/*blood , Thyroid Neoplasms/*blood, Biomarkers, Tumor/blood ; Carcinoma, Medullary/diagnosis ; Carcinoma, Neuroendocrine/diagnosis ; Diagnosis, Differential ; Humans ; Randomized Controlled Trials as Topic ; Thyroid Neoplasms/diagnosis ; Thyroid Nodule/blood ; Thyroid Nodule/diagnosis
مستخلص: Background: Thyroid nodules are very common in general medical practice, but rarely turn out to be a medullary thyroid carcinoma (MTC). Calcitonin is a sensitive tumour marker for the detection of MTC (basal calcitonin). Sometimes a stimulation test is used to improve specificity (stimulated calcitonin). Although the European Thyroid Association's guideline advocates calcitonin determination in people with thyroid nodules, the role of routine calcitonin testing in individuals with thyroid nodules is still questionable.
Objectives: The objective of this review was to determine the diagnostic accuracy of basal and/or stimulated calcitonin as a triage or add-on test for detection of MTC in people with thyroid nodules.
Search Methods: We searched CENTRAL, MEDLINE, Embase and Web of Science from inception to June 2018.
Selection Criteria: We included all retrospective and prospective cohort studies in which all participants with thyroid nodules had undergone determination of basal calcitonin levels (and stimulated calcitonin, if performed).
Data Collection and Analysis: Two review authors independently scanned all retrieved records. We extracted data using a standard data extraction form. We assessed risk of bias and applicability using the QUADAS-2 tool. Using the hierarchical summary receiver operating characteristic (HSROC) model, we estimated summary curves across different thresholds and also obtained summary estimates of sensitivity and specificity at a common threshold when possible.
Main Results: In 16 studies, we identified 72,368 participants with nodular thyroid disease in whom routinely calcitonin testing was performed. All included studies performed the calcitonin test as a triage test. Median prevalence of MTC was 0.32%. Sensitivity in these studies ranged between 83% and 100% and specificity ranged between 94% and 100%. An important limitation in 15 of the 16 studies (94%) was the absence of adequate reference standards and follow-up in calcitonin-negative participants. This resulted in a high risk of bias with regard to flow and timing in the methodological quality assessment. At the median specificity of 96.6% from the included studies, the estimated sensitivity (95% confidence interval (CI)) from the summary curve was 99.7% ( 68.8% to 100%). For the median prevalence of MTC of 0.23%, the positive predictive value (PPV) for basal calcitonin testing at a threshold of 10 pg/mL was 7.7% (4.9% to 12.1%). Summary estimates of sensitivity and specificity for the threshold of 10 pg/mL of basal calcitonin testing was 100% (95% CI 99.7 to 100) and 97.2% (95% CI 95.9 to 98.6), respectively. For combined basal and stimulated calcitonin testing, sensitivity ranged between 82% and 100% with specificity between 99% and 100%. The median specificity was 99.8% with an estimated sensitivity of 98.8% (95% CI 65.8 to 100) .
Authors' Conclusions: Both basal and combined basal and stimulated calcitonin testing have a high sensitivity and specificity. However, this may be an overestimation due to high risk of bias in the use and choice of reference standard The value of routine testing in patients with thyroid nodules remains questionable, due to the low prevalence, which results in a low PPV of basal calcitonin testing. Whether routine calcitonin testing improves prognosis in MTC patients remains unclear.
(Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)
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المشرفين على المادة: 0 (Biomarkers, Tumor)
9007-12-9 (Calcitonin)
SCR Disease Name: Thyroid cancer, medullary
تواريخ الأحداث: Date Created: 20200317 Date Completed: 20200826 Latest Revision: 20240903
رمز التحديث: 20240903
مُعرف محوري في PubMed: PMC7075519
DOI: 10.1002/14651858.CD010159.pub2
PMID: 32176812
قاعدة البيانات: MEDLINE
الوصف
تدمد:1469-493X
DOI:10.1002/14651858.CD010159.pub2