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Meta-Analysis
. 2023 Aug;24(4):685-694.
doi: 10.1007/s11154-023-09811-7. Epub 2023 May 31.

Prevalence and significance of indeterminate calcitonin values in patients with thyroid nodules: A systematic review and meta-analysis

Tommaso Piticchio  1 , Francesco Frasca  1 , Pierpaolo Trimboli  2   3
Affiliations
Meta-Analysis

Prevalence and significance of indeterminate calcitonin values in patients with thyroid nodules: A systematic review and meta-analysis

Tommaso Piticchio et al. Rev Endocr Metab Disord. 2023 Aug.

Abstract

Background: Although calcitonin (Ctn) measurement is recognized as the most accurate diagnostic test for medullary thyroid carcinoma (MTC), its routine execution is not universally accepted for several reasons, including the lack of recommendations for managing indeterminate Ctn values (ICV); such as 10-to-100 pg/mL. This study aimed to gather data on 1) the frequency of ICV among patients undergoing Ctn test and 2) the MTC rate among patients with ICV.

Methods: This review was conducted according to the Meta-analyses Of Observational Studies in Epidemiology guidelines. PubMed and Cochrane databases were searched, with no language restrictions. The final search was completed on January 2023. Then, quality assessment and proportion meta-analyses were performed.

Results: The online search retrieved 233 articles and 15 were included for quantitative analysis. The risk of bias was low. The number of patients undergone Ctn testing was 29,533. The pooled percentage of those with ICV was 1.7% (95% confidence interval [CI]:1.2-2.3). The pooled proportion of MTC incidence among patients with ICV was 9.6% (95% CI:5-14.1). Heterogeneity was explained by the covariates of Ctn assay sensitivity and the resection rate. The subgroup with Ctn 10-20 pg/mL showed a significantly lower MTC rate than the subgroup with Ctn 20-100 pg/mL.

Conclusions: The percentage of ICV among patients with thyroid nodules who underwent Ctn testing is negligible. The rate of MTC in patients with ICV cannot be overlooked. Among the ICV intervals, the risk of MTC increases significantly when Ctn is above 20 pg/mL.

Keywords: Calcitonin; Medullary thyroid carcinoma; Meta-analysis; Systematic review; Thyroid.

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Conflict of interest statement

The authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
Flow of records found. Reason of exclusion of papers is reported in the text
Fig. 2
Fig. 2
Forest plot meta-analysis of ICV among total number of patients screened for Ctn. Any square identifies the weight of the study. The diamond represents the pooled result and its wideness indicates 95%CI
Fig. 3
Fig. 3
Forest plot meta-analysis of MTC recorded among ICV patients. Any square identifies the weight of the study. The diamond represents the pooled result and its wideness indicates 95%CI
Fig. 4
Fig. 4
Meta-regression analysis using the covariate resection rate to explain the heterogeneous MTC rate among articles. Any circle identifies one study, and its size differs according to the study weight
Fig. 5
Fig. 5
Forest plot meta-analysis of MTCs recorded within different ICV intervals. Any square identifies the weight of the study. The diamonds represent the pooled results and their wideness indicates 95% CI. The pooled MTC percentage of 12% derives from the included studies and differs from that recorded when including all studies
See this image and copyright information in PMC

References

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