甲状腺结节患者常规行血清降钙素检查对早期发现甲状腺髓样癌的临床价值

Clinical value of routine serum calcitonin measurement for early detection of medullary thyroid carcinoma in patients with thyroid nodules

目的:探讨甲状腺结节患者血清降钙素(Ct)检测对甲状腺髓样癌(MTC)的诊断价值。方法:回顾性分析2016年10月—2017年8月1922例因甲状腺结节就诊于郑州大学第一附属医院甲状腺外科并行手术治疗的患者资料。所有患者术前均常规行血清Ct检测,术后均有明确的常规病理结果。分析Ct水平与MTC的关系、用受试者工作特征曲线分析Ct对MTC的诊断效能。结果:在1922例甲状腺结节患者中,新发现的MTC患者有12例(0.62%)。在术前血清Ct值为10~100pg/mL的155例、>100~500pg/mL的12例和>500pg/mL的10例中,术后确诊为MTC的分别为1例(0.65%)、1例(8.33%)和9例(90.00%)。在血清Ct>500pg/mL的9例MTC患者中,有8例(88.89%)出现了不同程度的颈部淋巴结转移。血清Ct诊断MTC的截断值为258.5pg/mL,敏感性为90.91%,特异性为96.99%。结论:术前常规检测血清Ct有助于MTC的早期诊断,对患者接受彻底的手术治疗,避免二次手术有十分重要的意义。

Objective： To investigate the value of serum calcitonin（Ct） detection for diagnosis of medullary thyroid carcinoma（MTC） in patients with thyroid nodules. Methods： The clinical data of 1 922 patients admitted to the Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University due to thyroid nodules and undergoing surgical treatment from October 2016 to August 2017 were retrospectively analyzed. All patients underwent routine serum Ct detection before operation, and had definite postoperative pathological diagnosis. The relationship between Ct level and MTC was analyzed, and the diagnostic efficiency of Ct for MTC was evaluated by receiver operating characteristic curve analysis.Results： In the 1 922 patients with thyroid nodules, 12 cases（0.62%） were newly diagnosed as MTC. In 155 patients with preoperative Ct value ranging from 10 to 100 pg/mL, 12 patients with preoperative Ct value ranging from more than 100 to 500 pg/mL and 10 patients with preoperative Ct value more than 500 pg/mL, MTC was diagnosed in one case（0.65%）, one case（8.33%） and 9 cases（90.00%）, respectively. In the 9 MTC patients with preoperative Ct value more than 500 pg/mL, 8 cases（88.89%） had different levels of cervical lymph node metastasis. The cut-off value of serum Ct for diagnosis of MTC was 258.5 pg/mL, with a sensitivity of 90.91% and a specificity of 96.99%. Conclusion： Routine preoperative serum Ct detection is helpful for the early diagnosis of MTC, and it has great importance in patients for receiving thorough surgical resection and avoiding repeated operation.