Franz Sesti, Tiziana Feola, Pasquale Dolce, Valentina Guarnotta, Alessandro Veresani, Elia Guadagno, Filomena Bottiglieri, Maria Grazia Tarsitano, Andrea M Isidori, Annamaria Colao, Antongiulio Faggiano, Elisa Giannetta
{"title":"钙刺激试验在诊断甲状腺髓样癌中的作用：是否足以在两性中获得诊断？个体患者数据荟萃分析。","authors":"Franz Sesti, Tiziana Feola, Pasquale Dolce, Valentina Guarnotta, Alessandro Veresani, Elia Guadagno, Filomena Bottiglieri, Maria Grazia Tarsitano, Andrea M Isidori, Annamaria Colao, Antongiulio Faggiano, Elisa Giannetta","doi":"10.1530/ETJ-24-0347","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Early diagnosis of medullary thyroid cancer (MTC) when basal calcitonin (CT) levels are <100 pg/ml remains a clinical challenge. The calcium stimulation test is a unique tool for stimulating CT. However, standardized and sex-specific cutoff values are lacking. Therefore, this study aimed to investigate whether the calcium stimulation test for CT is adequate for diagnosing MTC in both sexes and to identify sex-specific cutoff values.</p><p><strong>Methods: </strong>This was an individual patient data (IPD) meta-analysis. A literature search was performed using Scopus, PubMed, and Web of Science until September, 2024, to identify articles on the calcium stimulation test for diagnosing MTC.</p><p><strong>Results: </strong>A total of five studies involving 243 patients (148 females and 95 males) who underwent total thyroidectomy were included in this study. Before surgery, all patients underwent the calcium stimulation test with calcium gluconate (25 mg/kg) for CT assessed by chemiluminescence assay. In females, a global threshold of 162 pg/ml was identified with a pooled sensitivity of 0.90 [95% confidence interval (95%CI) 0.79-0.97] and specificity of 0.66 (95%CI 0.56-0.75). The pooled area under the curve (AUC) was 0.87 (95%CI 0.76-0.97). In males, a global threshold of 562 pg/ml was identified with a pooled sensitivity of 0.79 (95%CI 0.60-0.92) and specificity of 0.89 (95%CI 0.79-0.96). The pooled AUC was 0.94 (95%CI 0.90-0.99).</p><p><strong>Conclusions: </strong>The calcium stimulation test for CT for the diagnosis of MTC showed better performance in males than in females, with a suggested cutoff value of 562 pg/ml in males.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":" ","pages":""},"PeriodicalIF":3.5000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Role of the Calcium Stimulation Test in Diagnosing Medullary Thyroid Cancer: Is It Adequate to Achieve a Diagnosis in Both Sexes? An Individual Patient Data Meta-analysis.\",\"authors\":\"Franz Sesti, Tiziana Feola, Pasquale Dolce, Valentina Guarnotta, Alessandro Veresani, Elia Guadagno, Filomena Bottiglieri, Maria Grazia Tarsitano, Andrea M Isidori, Annamaria Colao, Antongiulio Faggiano, Elisa Giannetta\",\"doi\":\"10.1530/ETJ-24-0347\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Early diagnosis of medullary thyroid cancer (MTC) when basal calcitonin (CT) levels are <100 pg/ml remains a clinical challenge. The calcium stimulation test is a unique tool for stimulating CT. However, standardized and sex-specific cutoff values are lacking. Therefore, this study aimed to investigate whether the calcium stimulation test for CT is adequate for diagnosing MTC in both sexes and to identify sex-specific cutoff values.</p><p><strong>Methods: </strong>This was an individual patient data (IPD) meta-analysis. A literature search was performed using Scopus, PubMed, and Web of Science until September, 2024, to identify articles on the calcium stimulation test for diagnosing MTC.</p><p><strong>Results: </strong>A total of five studies involving 243 patients (148 females and 95 males) who underwent total thyroidectomy were included in this study. Before surgery, all patients underwent the calcium stimulation test with calcium gluconate (25 mg/kg) for CT assessed by chemiluminescence assay. In females, a global threshold of 162 pg/ml was identified with a pooled sensitivity of 0.90 [95% confidence interval (95%CI) 0.79-0.97] and specificity of 0.66 (95%CI 0.56-0.75). The pooled area under the curve (AUC) was 0.87 (95%CI 0.76-0.97). In males, a global threshold of 562 pg/ml was identified with a pooled sensitivity of 0.79 (95%CI 0.60-0.92) and specificity of 0.89 (95%CI 0.79-0.96). The pooled AUC was 0.94 (95%CI 0.90-0.99).</p><p><strong>Conclusions: </strong>The calcium stimulation test for CT for the diagnosis of MTC showed better performance in males than in females, with a suggested cutoff value of 562 pg/ml in males.</p>\",\"PeriodicalId\":12159,\"journal\":{\"name\":\"European Thyroid Journal\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2025-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Thyroid Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1530/ETJ-24-0347\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Thyroid Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1530/ETJ-24-0347","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
Role of the Calcium Stimulation Test in Diagnosing Medullary Thyroid Cancer: Is It Adequate to Achieve a Diagnosis in Both Sexes? An Individual Patient Data Meta-analysis.
Background: Early diagnosis of medullary thyroid cancer (MTC) when basal calcitonin (CT) levels are <100 pg/ml remains a clinical challenge. The calcium stimulation test is a unique tool for stimulating CT. However, standardized and sex-specific cutoff values are lacking. Therefore, this study aimed to investigate whether the calcium stimulation test for CT is adequate for diagnosing MTC in both sexes and to identify sex-specific cutoff values.
Methods: This was an individual patient data (IPD) meta-analysis. A literature search was performed using Scopus, PubMed, and Web of Science until September, 2024, to identify articles on the calcium stimulation test for diagnosing MTC.
Results: A total of five studies involving 243 patients (148 females and 95 males) who underwent total thyroidectomy were included in this study. Before surgery, all patients underwent the calcium stimulation test with calcium gluconate (25 mg/kg) for CT assessed by chemiluminescence assay. In females, a global threshold of 162 pg/ml was identified with a pooled sensitivity of 0.90 [95% confidence interval (95%CI) 0.79-0.97] and specificity of 0.66 (95%CI 0.56-0.75). The pooled area under the curve (AUC) was 0.87 (95%CI 0.76-0.97). In males, a global threshold of 562 pg/ml was identified with a pooled sensitivity of 0.79 (95%CI 0.60-0.92) and specificity of 0.89 (95%CI 0.79-0.96). The pooled AUC was 0.94 (95%CI 0.90-0.99).
Conclusions: The calcium stimulation test for CT for the diagnosis of MTC showed better performance in males than in females, with a suggested cutoff value of 562 pg/ml in males.
期刊介绍：
The ''European Thyroid Journal'' publishes papers reporting original research in basic, translational and clinical thyroidology. Original contributions cover all aspects of the field, from molecular and cellular biology to immunology and biochemistry, from physiology to pathology, and from pediatric to adult thyroid diseases with a special focus on thyroid cancer. Readers also benefit from reviews by noted experts, which highlight especially active areas of current research. The journal will further publish formal guidelines in the field, produced and endorsed by the European Thyroid Association.
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