Thresholds for Preop Serum Calcitonin Predict Lymph Node Metastasis in Thyroid Cancer
WEDNESDAY, July 2, 2025 -- Updated threshold values of preoperative serum calcitonin predict different extents of lymph node metastasis (LNM) in patients with medullary thyroid cancer (MTC), according to a study published in the August issue of JAMA Otolaryngology-Head & Neck Surgery.
Yuxin Du, M.D., from the Fudan University Shanghai Cancer Center, and colleagues updated the optimal thresholds of basal serum calcitonin levels for predicting the extent of LNM in a retrospective cohort study. Five hundred nine patients with initially treated MTC who had their preoperative basal calcitonin levels tested using electrochemiluminescence or chemiluminescence between 2011 and 2024 were included and were randomly divided into a training cohort and validation cohort (2:1 ratio).
Patients were categorized based on the extent of LNM: no LNM, central LNM, lateral LNM, and upper mediastinal LNM. The researchers found that preoperative calcitonin levels were positively correlated with the extent of LNM. Preoperative basal calcitonin thresholds associated with different extents of LNM were identified using the training cohort: 241.9; 693.9; 2,787.1; and 2,378.5 pg/mL for central LNM, ipsilateral lateral LNM, upper mediastinal LNM, and bilateral and/or contralateral lateral LNM, respectively. The proposed thresholds outperformed those recommended by the American Thyroid Association guidelines in both the training and validation cohorts in prediction of LNM and in discrimination of structural recurrence-free survival.
"This research aims to provide a solid theoretical foundation for future prospective clinical studies that investigate the use of preoperative calcitonin levels to guide the scope of selective neck dissection in patients with MTC," the authors write.
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