Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access |
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Original Article
Volume 7, Number 1, February 2017, pages 5-17
Modified Fine-Needle Aspiration Biopsy for Calcitonin, Procalcitonin and Carcinoembryonic Antigen Levels in the Diagnosis of Thyroid Nodules With Medullary Thyroid Carcinoma
Figures
Tables
Serum levels | Minutes post-calcium administration | ||||
---|---|---|---|---|---|
0 | 2 | 5 | 10 | 15 | |
Calcium gluconate (2.5 mg/kg) was administered intravenously over 1 min and blood samples were obtained at the indicated various time intervals as mentioned in “Methods” [22]. Reference values: basal serum Ct 0.0 - 8.4 pg/mL, basal PCt 0.00 - 0.50 ng/mL, CEA 0.2 - 4.7 ng/mL. The serum Ct threshold for the identification of MTC was defined a > 26 pg/mL for basal levels in females [22]. The threshold for calcium-stimulated Ct level was > 79 pg/mL in females [22]. The threshold for calcium-stimulated PCt level was > 1.65 ng/mL. The threshold for stimulated CEA was considered as 17.16 ng/mL. | |||||
Calcium (mg/dL) | |||||
Patient 1 | 9.5 | 10.6 | 11.1 | 10.7 | 9.6 |
Patient 2 | 9.9 | 11.6 | 11.2 | 10.8 | 9.8 |
Patient 3 | 9.0 | 10.4 | 10.9 | 10.9 | 9.4 |
Calcitonin (pg/mL) | |||||
Patient 1 | 41 | 555 | 642 | 889 | 718 |
Patient 2 | 58 | 78 | 142 | 123 | 82 |
Patient 3 | 69 | 439 | 320 | 184 | 98 |
Procalcitonin (ng/mL) | |||||
Patient 1 | 0.32 | 2.32 | 3.99 | 1.78 | 1.05 |
Patient 2 | 2.48 | 6.30 | 6.97 | 7.11 | 4.88 |
Patient 3 | 0.42 | 1.45 | 3.94 | 1.01 | 1.38 |
Carcinoembryonic antigen (ng/mL) | |||||
Patient 1 | 2.50 | 2.81 | 2.32 | 2.00 | 2.86 |
Patient 2 | 1.86 | 1.76 | 1.75 | 1.69 | 1.83 |
Patient 3 | 3.22 | 4.10 | 3.84 | 3.46 | 3.09 |
Tumor markers | Serum | FNB aspirate |
---|---|---|
Levels of Ct, PCt and CEA, in fine-needle aspirates (FNB) were determined as mentioned in “Methods”. Blood was drawn just prior to performing FNB for the determination of serum levels of Ct, PCt and CEA. Patient 1 had three nodules and all three nodules were biopsied. Rt thyroid nodule, 1a and the adjacent second Rt nodule, 1b were biopsied together and considered as a single aspirate sample as mentioned in “Methods”. In this patient, Lt thyroid nodule, 2a was also biopsied. In patient 2, the right lobe nodule,1a was biopsied. Patient 3 had bilateral thyroid nodules which were biopsied (Rt thyroid nodule,1a Lt thyroid nodule, 2b) as outlined in “Methods”. Reference ranges: basal serum Ct 0.0 - 8.4 pg/mL, basal PCt 0.00 - 0.50 ng/mL, CEA 0.2 - 4.7 ng/mL. The basal serum Ct threshold for the identification of MTC was defined as > 26 pg/mL for females [22]. The threshold for calcium-stimulated Ct level of > 1,000 pg/mL in needle biopsy samples was considered diagnostic for MTC [24]. The diagnostic values for FNB aspirate samples for PCt and CEA were > 2.0 and > 18 ng/mL, respectively. | ||
Calcitonin (pg/mL) | ||
Patient 1 | 48 | 726 (Rt thyroid nodule-1a and 1b) 824 (Lt thyroid nodule-2a) |
Patient 2 | 52 | 1,996 (Rt thyroid nodule-1a) |
Patient 3 | 70 | 744 (Rt thyroid nodule-1a) 1,120 (Lt thyroid nodule-2a) |
Procalcitonin (ng/mL) | ||
Patient 1 | 0.92 | 1.6 (Rt thyroid nodule-1a and 1b) 2.0 (Lt thyroid nodule-2a) |
Patient 2 | 3.2 | 4.4 (Rt thyroid nodule-1a) |
Patient 3 | 0.61 | 1.8 (Rt thyroid nodule-1a) 8.0 (Lt thyroid nodule-2b) |
Carcinoembryonic antigen (ng/mL) | ||
Patient 1 | 2.9 | 13.9 (Rt thyroid nodule-1a and 1b) 14.2 (Lt thyroid nodule-2a) |
Patient 2 | 166 | 21.6 (Rt thyroid nodule-1a) |
Patient 3 | 4 | 17.7 (Rt thyroid nodule-1a) 19.6 (Lt thyroid nodule-2b) |
Tumor markers | Serum | MFNB aspirate |
---|---|---|
Levels of Ct, PCt and CEA, in modified fine-needle aspirates (MFNB) were determined as mentioned in “Methods”. Blood was drawn just prior to performing MFNB for the determination of serum levels of Ct, PCt and CEA. Patient 1 had three nodules and all three nodules were biopsied. Rt thyroid nodule, 1a and the adjacent second Rt nodule, 1b were biopsied together and considered as a single aspirate sample as mentioned in “Methods”. In this patient, Lt thyroid nodule, 2a was also biopsied. In patient 2, the right lobe nodule, 1a was biopsied. Patient 3 had bilateral thyroid nodules which were biopsied (Rt thyroid nodule, 1a and Lt thyroid nodule, 2b) as outlined in “Methods”. Reference ranges: basal serum Ct 0.0 - 8.4 pg/mL, basal PCt 0.00 - 0.50 ng/mL, CEA 0.2 - 4.7 ng/mL. The basal serum Ct threshold for the identification of MTC was defined as > 26 pg/mL for females [22]. The threshold for Ct level of > 1,000 pg/mL in needle biopsy samples was considered diagnostic for MTC [24]. The diagnostic values for MFNB aspirate samples for PCt and CEA were > 2.0 and > 18 ng/mL. | ||
Calcitonin (pg/mL) | ||
Patient 1 | 52 | 1,036 (Rt thyroid nodules-1a and 1b) 1,870 (Lt thyroid nodule-2a) |
Patient 2 | 68 | 1,440 (Rt thyroid nodule-1a) |
Patient 3 | 82 | 1,341 (Rt thyroid nodule-1a) 1,328 (Lt thyroid nodule-2a) |
Procalcitonin (ng/mL) | ||
Patient 1 | 0.48 | 3.2 (Rt thyroid nodule-1a and 1b) 2.8 (Lt thyroid nodule-2a) |
Patient 2 | 2.40 | 7.8 (Rt thyroid nodule 1a) |
Patient 3 | 0.43 | 6.8 (Rt thyroid nodule-1a) 9.2 (Lt thyroid nodule-2b) |
Carcinoembryonic antigen (ng/mL) | ||
Patient 1 | 3.1 | 21.9 (Rt thyroid nodule (1a and 1b) 18.6 (Lt thyroid nodule-2a) |
Patient 2 | 170 | 29.9 (Rt thyroid nodule-1a) |
Patient 3 | 3.6 | 52.3 (Rt thyroid nodule-1a) 28.1 (Lt thyroid nodule-2b) |
Serum levels | Minutes post-calcium stimulation | ||||
---|---|---|---|---|---|
0 | 2 | 5 | 10 | 15 | |
Calcium gluconate (2.5 mg/kg) was administered intravenously over 1 min and blood samples were obtained at the indicated various time intervals as mentioned in “Methods”. Reference ranges: basal serum Ct 0.0 - 8.4 pg/mL, basal PCt 0.00 - 0.50 ng/mL, CEA 0.2 - 4.7 ng/mL. The serum Ct threshold for the identification of MTC was defined as > 26 pg/mL for basal levels in females [22]. The threshold for calcium-stimulated Ct levels was > 79 pg/mL in females [22]. In this study, the basal serum threshold for PCt was defined as > 0.5 ng/mL and the threshold for calcium-stimulated abnormal PCt level was defined as > 1.65 ng/mL. The threshold for basal CEA was > 5.0 ng/mL and the threshold for stimulated CEA was considered as 17.16 ng/mL. | |||||
Calcium (mg/dL) | |||||
Patient 1 | 8.6 | 10.1 | 10.0 | 9.1 | 9.3 |
Patient 2 | 9.2 | 10.4 | 10.3 | 9.4 | 9.6 |
Patient 3 | 8.6 | 10.0 | 9.6 | 9.6 | 9.5 |
Patient 4 | 8.9 | 10.6 | 10.1 | 9.8 | 9.4 |
Calcitonin (pg/mL) | |||||
Patient 1 | 30 | 125 | 88 | 47 | 30 |
Patient 2 | 39 | 112 | 97 | 58 | 44 |
Patient 3 | 2.9 | 36 | 24 | 17 | 4.2 |
Patient 4 | 27 | 56 | 48 | 42 | 22 |
Procalcitonin (pg/mL) | |||||
Patient 1 | 0.14 | 0.15 | 0.13 | 0.12 | 0.13 |
Patient 2 | 0.05 | 0.05 | 0.005 | 0.05 | 0.05 |
Patient 3 | 0.16 | 0.13 | 0.15 | 0.17 | 0.18 |
Patient 4 | 0.18 | 0.10 | 0.05 | 0.05 | 0.05 |
Carcinoembryonic antigen (ng/mL) | |||||
Patient 1 | 0.24 | 0.23 | 0.20 | 0.25 | 0.21 |
Patient 2 | 1.6 | 1.5 | 1.6 | 1.5 | 1.5 |
Patient 3 | 1.7 | 1.6 | 1.2 | 1.4 | 1.5 |
Patient 4 | 0.8 | 0.9 | 1.0 | 0.45 | 0.67 |
Serum | MFNB aspirate | |
---|---|---|
Blood was drawn for the determination of Ct, PCt, and CEA levels just prior to performing MFNB. In patients 1 - 3 only MFNB was performed and the aspirate results are shown above. In patient 4, initially FNB was performed which showed abnormal cells suggestive of follicular neoplasm and in this patient the FNB aspirate samples showed low values of Ct, PCt, and CEA (data not shown). In this patient MFNB was performed subsequently and the cytology report was consistent with papillary thyroid cancer and the MFNB results are shown in this Table. Reference ranges: basal serum Ct 0.0 - 8.4 pg/mL, basal PCt 0.00 - 0.50 ng/mL, CEA 0.2 - 4.7 ng/mL. The MTC diagnostic value for basal serum Ct level was > 26 pg/mL for females [22]. In this study, the basal serum threshold for PCt was defined as > 0.5 ng/mL and for CEA this value was > 5.0 ng/mL. The threshold for Ct level of > 1,000 pg/mL in needle biopsy samples was considered diagnostic for MTC [24]. The diagnostic values for MFNB aspirate samples for PCt and CEA were > 2.0 and > 18 ng/mL, respectively. | ||
Calcitonin (pg/mL) | ||
Patient 1 | 28 | 3.2 |
Patient 2 | 44 | < 0.05 |
Patient 3 | 4.7 | 1.9 |
Patient 4 | 33 | 2.7 |
Procalcitonin (ng/mL) | ||
Patient 1 | 0.12 | 0.22 |
Patient 2 | 0.41 | 0.43 |
Patient 3 | 0.36 | 0.19 |
Patient 4 | 0.18 | 0.38 |
Carcinoembryonic antigen (ng/mL) | ||
Patient 1 | 2.9 | 3.7 |
Patient 2 | 2.2 | 2.4 |
Patient 3 | 1.3 | 3.2 |
Patient 4 | 4.1 | 3.6 |