Preoperative Serum Calcitonin Thresholds as Predictors of Lymph Node Metastasis in Thyroid Cancer

Recent research published in the August issue of JAMA Otolaryngology–Head & Neck Surgery highlights the significance of preoperative serum calcitonin levels in predicting the extent of lymph node metastasis (LNM) in patients with medullary thyroid cancer (MTC). The study, conducted by Yuxin Du, M.D., and colleagues from Fudan University Shanghai Cancer Center, provides updated threshold values for basal serum calcitonin that correlate with different levels of lymph node involvement.

Involving 509 patients with newly treated MTC, the retrospective cohort study analyzed preoperative calcitonin levels measured through electrochemiluminescence or chemiluminescence between 2011 and 2024. Patients were categorized based on the extent of LNM: no metastasis, central LNM, lateral LNM, and upper mediastinal LNM. The findings revealed that higher baseline calcitonin levels are positively associated with more extensive lymph node involvement.

Using data from the training cohort, researchers identified specific calcitonin thresholds that predict varying LNM extents: 241.9 pg/mL for central LNM, 693.9 pg/mL for ipsilateral lateral LNM, 2,787.1 pg/mL for upper mediastinal LNM, and 2,378.5 pg/mL for bilateral or contralateral lateral LNM. Notably, these thresholds outperformed current guidelines by the American Thyroid Association in predicting LNM and assessing the likelihood of structural recurrence-free survival.

The study underscores the potential of using preoperative calcitonin levels to guide surgical decision-making, especially regarding the scope of neck dissection in MTC cases. The authors emphasize that these findings establish a solid theoretical foundation for future prospective clinical trials aimed at optimizing surgical strategies based on calcitonin thresholds.

For more detailed information, refer to the publication: DOI: 10.1001/jamaoto.2025.0542. The research contributes to advancing personalized management of thyroid cancer and may influence future clinical guidelines.