4.6 Review

Evolution of thyroid cancer biomarkers: from laboratory test to patients' clinical management

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Summary: Different assays for thyroglobulin (Tg) and Tg antibodies (TgAb) can result in different classifications of response to therapy for differentiated thyroid cancer (DTC) patients, potentially significantly affecting clinical management. It is important to consider the variations between methods when using recommended Tg cut-offs in guidelines.

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Summary: Calcitonin is a hormone produced by the parafollicular cells of the thyroid gland that acts through the calcitonin receptor. In clinical practice, it is used for the diagnosis and follow-up of medullary thyroid carcinoma. Elevated basal calcitonin levels can indicate the presence of this type of carcinoma. This review provides current information on the synthesis and physiology of calcitonin, as well as its differential diagnosis in various clinical situations.

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Summary: The study evaluated the diagnostic performance of calcitonin (CT) and procalcitonin (PCT) in distinguishing between active and inactive medullary thyroid carcinoma (MTC) and between MTC and non-MTC thyroid diseases. PCT was found to be a highly sensitive and specific alternative marker for MTC, particularly useful in patients with positive CT results. Having both markers available on the same automated platform facilitates reflex strategies to refine laboratory diagnosis.

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Summary: This article summarizes the role of Tg measurement in DTC patients treated with complete thyroid ablation, thyroidectomy alone, or lobectomy, as well as the management of patients carrying positive TgAb. Experts suggest that patients with undetectable hsTg after total thyroid ablation can be safely managed by periodic hsTg measurement and selective use of imaging procedures in few cases.

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Procalcitonin measured by three different assays is an excellent tumor marker for the follow-up of patients with medullary thyroid carcinoma

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Summary: The study found that serum ProCT is a highly accurate test for diagnosing and monitoring MTC, with the potential to replace calcitonin as a new standard of care in MTC management.

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Marisa A. Bartz-Kurycki et al.

Summary: This study aims to provide updates on the diagnosis and treatment of MTC by reviewing clinical studies published between 2016 and 2021, focusing on advances in biochemical testing, imaging, surgical management, adjuvant therapies, and prognosis. Recent advances aim to diagnose MTC at earlier stages, predict the development of MTC in patients with hereditary syndromes, use functional imaging for metastases assessment, perform optimal surgery, employ targeted therapies for metastatic disease, and predict patient-specific outcomes.

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Utility of Serum Procalcitonin for Screening and Risk Stratification of Medullary Thyroid Cancer

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Luca Giovanella et al.

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False-positive calcitonin results in patients with benign goiter

Luca Giovanella et al.

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Thyroid volume influences serum calcitonin levels in a thyroid-healthy population: results of a 3-assay, 519 subjects study

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Medullary Thyroid Cancer: Management Guidelines of the American Thyroid Association

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Routine serum calcitonin measurement in the evaluation of thyroid nodules

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Pyocalcitonin assay in systemic inflammation, infection, and sepsis: Clinical utility and limitations

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Thyroglobulin assay 4 weeks after thyroidectomy predicts outcome in low-risk papillary thyroid carcinoma

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Phantoms in the assay tube: Heterophile antibody interferences in serum thyroglobulin assays

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High-sensitivity human thyroglobulin (hTG) immunoradiometric assay in the follow-up of patients with differentiated thyroid cancer

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