Análise das indicações de dosagem de calcitonina sérica realizada no Hospital das Clínicas de Botucatu
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Data
2019-07-31
Autores
Ferreira, Deborah Cristina Goulart
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Universidade Estadual Paulista (Unesp)
Resumo
Contexto: O carcinoma medular de tireoide (CMT) é um tumor raro, cujo diagnóstico precoce é extremamente relevante uma vez que sua evolução pode ser bastante agressiva. A dosagem sérica de calcitonina pode indicar o diagnóstico do CMT e é utilizada como marcador da presença de doença durante o seguimento dos pacientes. No Hospital das Clínicas da Faculdade de Medicina de Botucatu (HC-FMB), a dosagem do hormônio passou a ser realizada em 2008, sendo sua solicitação de livre acesso. Objetivos: Avaliar as solicitações de dosagem de calcitonina sérica no HC-FMB, independentemente do diagnóstico ou procedimento terapêutico realizados. Pacientes e Métodos: Foram avaliadas, retrospectivamente, todas as dosagens de calcitonina realizadas no Laboratório de Análises Clínicas do HC-FMB, no período de setembro de 2008 a junho de 2017. Foram então comparados os casos com calcitonina detectável ou não, aqueles com e sem CMT e os casos com solicitação de dosagem considerada adequada ou inadequada/não informada. Foi ainda quantificado o custo com as dosagens adequadas e inadequadas/não informadas. Resultados: Foram realizadas 1453 dosagens de calcitonina, em 915 pacientes, com concentrações detectáveis que variaram de 2,00 pg/mL a 527,00 pg/mL (mediana= 4,1 pg/mL). A mais frequente justificativa da coleta foi nódulo tireoidiano (73,9%). Dezenove pacientes (2,1%) apresentaram diagnóstico final de CMT. A maior parte dos casos apresentou calcitonina indetectável (82,7%). A maioria dos pacientes com CMT (73,7%) apresentou calcitonina detectável, sendo que 42,1% destes pacientes apresentaram concentrações superiores a 100 pg/mL. A indicação da coleta foi considerada adequada em 772 casos (84,4%) e inadequada/não informada em 143 casos (15,6%). Maiores percentuais de casos com solicitação de dosagem inadequada/não informada apresentaram o hormônio detectável (30,1%). Conclusões: A maior parte dos casos apresentou justificativa adequada para a coleta da calcitonina e a indicação mais frequente foi o nódulo tireoidiano. A maior parte dos casos apresentou o hormônio indetectável e não tinha CMT. Dos poucos casos com o tumor, a maior parte tinha calcitonina detectável. Maiores percentuais de casos com justificativa inadequada/não informada apresentaram calcitonina detectável.
Context: Medullary thyroid cancer (MTC) is a rare tumor, which early diagnosis is extremely relevant since its evolution can be quite aggressive. Serum calcitonin dosage may indicate the diagnosis of MTC and is used as a marker of the disease presence during the patients’ follow-up. At the Clinics Hospital of the School of Medicine of Botucatu (HC-FMB), the dosage of the hormone was first carried out in 2008, being its request of free access. Objectives: To evaluate the serum calcitonin dosage requirements in the HC-FMB, regardless of the diagnostic or therapeutic procedure carried out. Patients and Methods: All calcitonin dosages carried out at the Clinical Analysis Laboratory of HC-FMB from September 2008 to June 2017 were retrospectively evaluated. The cases with or without detectable calcitonin, as well as the cases with or without MTC, and the cases with adequate or inadequate/not informed dosage request were then compared. Costs with appropriate and inadequate/not informed dosages were also quantified. Results: 1453 calcitonin dosages have been carried out in 915 patients with detectable concentrations ranging from 2.00 pg/mL to 527.00 pg/mL (median = 4.1 pg/mL). The most frequent justification for the collection was thyroid nodule (73.9%). Nineteen patients (2.1%) were eventually diagnosed with MTC. The majority of cases had undetectable calcitonin (82.7%). The majority of MTC patients (73.7%) had detectable calcitonin, and 42.1% of those patients had concentrations above 100 pg/mL. The indication of the collection was considered adequate in 772 cases (84.4%) and inadequate/not informed in 143 cases (15.6%). Higher percentages of cases with inadequate/not informed dosing showed the detectable hormone (30.1%). Conclusions: Most of the cases presented adequate justification for the collection of calcitonin and the most frequent indication was the thyroid nodule. In most cases, the hormone was undetectable and MTC was not diagnosed. Of the few tumor cases, most of them had detectable calcitonin. Higher percentages of cases with inadequate/not informed justification showed detectable calcitonin.
Context: Medullary thyroid cancer (MTC) is a rare tumor, which early diagnosis is extremely relevant since its evolution can be quite aggressive. Serum calcitonin dosage may indicate the diagnosis of MTC and is used as a marker of the disease presence during the patients’ follow-up. At the Clinics Hospital of the School of Medicine of Botucatu (HC-FMB), the dosage of the hormone was first carried out in 2008, being its request of free access. Objectives: To evaluate the serum calcitonin dosage requirements in the HC-FMB, regardless of the diagnostic or therapeutic procedure carried out. Patients and Methods: All calcitonin dosages carried out at the Clinical Analysis Laboratory of HC-FMB from September 2008 to June 2017 were retrospectively evaluated. The cases with or without detectable calcitonin, as well as the cases with or without MTC, and the cases with adequate or inadequate/not informed dosage request were then compared. Costs with appropriate and inadequate/not informed dosages were also quantified. Results: 1453 calcitonin dosages have been carried out in 915 patients with detectable concentrations ranging from 2.00 pg/mL to 527.00 pg/mL (median = 4.1 pg/mL). The most frequent justification for the collection was thyroid nodule (73.9%). Nineteen patients (2.1%) were eventually diagnosed with MTC. The majority of cases had undetectable calcitonin (82.7%). The majority of MTC patients (73.7%) had detectable calcitonin, and 42.1% of those patients had concentrations above 100 pg/mL. The indication of the collection was considered adequate in 772 cases (84.4%) and inadequate/not informed in 143 cases (15.6%). Higher percentages of cases with inadequate/not informed dosing showed the detectable hormone (30.1%). Conclusions: Most of the cases presented adequate justification for the collection of calcitonin and the most frequent indication was the thyroid nodule. In most cases, the hormone was undetectable and MTC was not diagnosed. Of the few tumor cases, most of them had detectable calcitonin. Higher percentages of cases with inadequate/not informed justification showed detectable calcitonin.
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Palavras-chave
Calcitonina, Carcinoma Medular, Diagnóstico, Neoplasias da Glândula Tireoide, Calcitonin, Medullary Cance, Diagnosis, Thyroid Neoplasms