Ankara Med J. 2020; 20(3): 605-614 | DOI: 10.5505/amj.2020.25991

Is Evaluation of Serum Calcitonin Levels Significant for Patients with Thyroid Nodules?

Cevdet Aydýn¹, Oya Topaloglu¹, Berna Evranos Öðmen¹, Nagihan Bestepe², Serap Ulusoy³, Aysegul Aksoy Altinboga⁴, Reyhan Ersoy¹, Bekir Cakir^1
1Ankara Yildirim Beyazit University Faculty Of Medicine, Department Of Endocrinology And Metabolism, Ankara
²Ankara Atatürk Education And Research Hospital, Department Of Endocrinology And Metabolism, Ankara
³Ankara Atatürk Education And Research Hospital, Department Of General Surgery, Ankara
⁴Ankara Yildirim Beyazit University Faculty Of Medicine, Department Of Medical Pathology, Ankara

INTRODUCTION: The overdiagnostic analyses can be performed for evaluation of thyroid nodules which are commonly seen pathology in the population. Diagnostic tests in the evaluation of thyroid nodules, commonly-seen pathology in the population, mostly cause overdiagnosis. In fact, serum calcitonin(SC) measurement is a sensitive and specific method in the diagnosis of medullary thyroid cancer(MTC). If the patients with Bethesda Category III(atypia of undetermined significance -AUS) cytologies have also high risk clinical and ultrasonographical features, they can be evaluated for thyroidectomy. In this study, we aimed to evaluate the value of screening with serum calcitonin in patients with cytologies of Bethesda I and III categories.
METHODS: The medical records of patients who had thyroidectomy between 2007-2018 were screened retrospectively. The patients with preoperative calcitonin, cytology results and postoperative histopathology reports were included in the study.
RESULTS: Of the 6905 thyroidectomized patients, 881 had SC values. SC levels were evaluated as <2, 2-10 and >10pg/mL and classified as Group 1, 2, and 3; respectively. 217 patients(24.6%) had nondiagnostic(ND) and 275(31.2%) had AUS cytologies. The gender distribution was similar between ND and AUS groups(p=0.7). However, SC levels of group 1, 2, and 3 were found in 84.8%, 14.3%, and 0.9% of patients with ND, it was found in 82.9%, 15.6%, and 1.5% in patients with AUS cytologies, respectively(p=0.786). In histopathology, malignancy was detected in 30% of patients with AUS and 11.6% patients with ND(p=0.006). Calcitonin levels of patients with malignant histopathology were evaluated in 82.9%, 15.4%, and 1.7% of patients as Group 1, 2, and 3, respectively. This was similar compared to patients with benign histopathology (p=0.16). In the present study, 2 female patients had high calcitonin levels(144pg/mL and 655pg/mL). Both patients had preoperative AUS cytologies and final malignant histopathologies.
DISCUSSION AND CONCLUSION: We think that preoperative assessment of serum calcitonin levels can be useful in treatment decision of patients especially with Bethesda Category III thyroid nodules such as in follow-up and extent of surgery for cases planning surgery.

Keywords: Bethesda Category I, Bethesda Category III, calcitonin, thyroid nodule

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Tiroid Nodülü Olan Hastalarda Serum Kalsitonin Düzeyleri Bakmak Anlamlý mýdýr?

Cevdet Aydýn¹, Oya Topaloglu¹, Berna Evranos Öðmen¹, Nagihan Bestepe², Serap Ulusoy³, Aysegul Aksoy Altinboga⁴, Reyhan Ersoy¹, Bekir Cakir^1
1Ankara Yýldýrým Beyazýt Üniversitesi Týp Fakültesi, Endokrinoloji Ve Metabolizma Hastalýklarý Bilim Dalý, Ankara
²Ankara Atatürk Eðitim Ve Araþtýrma Hastanesi, Endokrinoloji Ve Metabolizma Hastalýklarý Kliniði, Ankara
³Ankara Atatürk Eðitim Ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ankara
⁴Ankara Yýldýrým Beyazýt Üniversitesi Týp Fakültesi, Týbbi Patoloji Anabilim Dalý, Ankara

GÝRÝÞ ve AMAÇ: Toplumda sýk görülen tiroid nodüllerinin deðerlendirilmesinde aþýrý taný kapsamýnda deðerlendirilebilecek tetkikler istenebilmektedir. Serum kalsitonin düzeyi aslýnda medüller tiroid kanseri (MTK) tanýsý için duyarlý ve özgül bir yöntemdir. Bethesda kategori III (önemi belirsiz atipi-ÖBA) sitolojisi olan hastalar klinik ve sonografik olarak yüksek riskli ise tiroidektomi açýsýndan deðerlendirilebilir. Bu çalýþmamýzda Tiroid Ýnce Ýðne Aspirasyon sitolojisi Bethesda I ve III kategorisinde olan hastalarýmýzda retrospektif deðerlendirme ile serum kalsitonin ile taramanýn deðerini irdelemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Kliniðimizde 2007-2018 tarihleri arasýnda tiroidektomi yapýlan hastalar arasýndan preoperatif serum kalsitonin düzeyi bakýlan hastalarýn sitoloji ve histopatoloji sonuçlarý retrospektif olarak deðerlendirildi.
BULGULAR: Opere olan 6905 hasta içinde serum kalsitonin bakýlan hasta sayýsý 881 olarak saptandý. Kalsitonin deðerleri <2, 2-10 ve >10 pg/mL olarak 3 ayrý grupta (sýrasýyla; Grup 1,2 ve 3) sýnýflandýrýldý. Bu hastalarýn 217’si (%24,6) tanýsal olmayan (TO), 275’i (%31,2) ÖBA idi. TO ve ÖBAlý hastalarda cinsiyet daðýlýmý benzerdi (p=0,7). TO hastalarýnýn % 84,8’inde kalsitonin düzeyleri 1. grupta, %14,3’ünde 2. grupta ve %0,9’u 3. grupta yer alýrken, ÖBA’lý hastalarýn %82,9’u 1. grupta, %15,6’sý 2. grupta ve %1,5’i 3. grupta yer alýyordu (p=0,786). ÖBA olan hastalarýn %30’unda histopatolojide malignite saptanýrken, ND grubundaki hastalarýn %11,6’sýnda malignite saptandý (p=0,006). Histopatolojide malign saptanan hastalarda kalsitonin deðerlerinin %82,9’u 1. grupta, %15,4’ü 2. grupta ve %1,7’si 3. grupta iken benign saptanan hastalarla kýyaslandýðýnda bu oranlar benzerdi (p=0,16). Çalýþmada 2 kadýn hastanýn kalsitonin düzeyleri çok yüksekti (144 pg/mL ve 655 pg/mL). Ýki hastanýn da preoperatif sitolojisi ÖBA ve histopatolojisi maligndi.
TARTIÞMA ve SONUÇ: Özellikle Bethesda Kategori III tiroid nodüllerinde cerrahi kararý verirken hem tiroidektominin tipini belirlemek hem de takip seçeneði tercih edildiðinde serum kalsitonin düzeyini bilmenin faydalý olabileceðini düþünmekteyiz.

Anahtar Kelimeler: Bethesda Kategori I, Bethesda Kategori III, Kalsitonin, Tiroid nodülü

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