Value Of Dignosis And Monitor In The Therapy Of Medullary Thyroid Carcinoma Through Detection Of Serum CGA

ObjectiveThyroid cancer is one of the most common endocrine systems of Clinical Oncology,its clinical manifestations is generally painless thyroid nodules,but in the normal population,the ratio of palpable thyroid nodules is about 3~7%.With the high-resolution ultrasound,the det-ection rate increase to 20% ~76%.Most patients with thyroid nodules have no clinical symptoms.When associated with thyroid dysfunction,there may be a corresponding clinical manifestations.Because of nodules oppressing surrounding tissue,some patients will appear the compressed symptoms of hoarseness,difficulty breathing and swallowing.About 5% ~15% of thyroid nodules were malignant,named thyroid carcinoma.The vast majority of thyroid cancer originated in the follicular epithelial cells,and it can be divided into papillary carcinoma,follicular carcinoma,medullary thyroid carcinoma and undifferentiated carcinoma according to the pathological type.Among them,medullary thyroid carcinoma thyroid derives from parafollicular cells(also called C cells)which can secret calcitonin,is a neuro-endocrine cells,it can produce a variety of neuroendocrine substances,so the medullary thy-roid carcinoma belongs to neuroendocrine tumors.Diagnosis of thyroid cancer mainly include serum thyroid immunoglobulin,ultrasound,CT,MRI,thyroid scintigraphy and fine needle aspiration biopsy(FNAB).One of the most valuable diagnostic method is FNAB,although having a high sensitivity and specificity,but this method has some false negative rate,but does not determine the nature of part of the thyroid disease pathology specimens,and secondly it is a invasive examination,puncture process will result in the proliferation of local tumor lesions.And sometimes we can not tell the type of the thyroid disease according to the pathology specimen.Otherwise,this is an invasive examination,puncture process will result in the proliferation of local tumor lesions.Recently,molecular biology and immunology tech-nology has made great development and progress,people also have deeperknowledge and understanding about thyroid cancer pathogenesis.It has now been found that many molecular markers are relative with thyroid cancer occurrence,development and outcomes.The resear-chers showed that chromogranin A were expressed in a variety of tumors.CGA is the detecti-on markers of neuroendocrine tumors which is relatively specific,sensitive and reliable,play-ing a major role in tumor diagnosis.It has very important value for early detection and treatment of cancer to establish the relationship between serum CGA levels and the diagnosis and prognosis of various endocrine tumors as soon as possible.But the value of the detection of chromogranin A in the diagnosis of thyroid cancer has no relevant reports.To investigate the diagnostic significance of the serum chromogranin A(CgA)for thyroid cancer,at the same time,to understand the role of disease monitoring and evaluation of the efficacy in patients.MethodsDetermine serum CGA levels of 383 cases of thyroid cancer in patients by enzymelinked immunosorbent assay.383 cases include 100 cases of thyroid cancer in patients with papillary thyroid cancer,100 cases of benign thyroid nodules,83 cases of patients with medullary thyroid cancer,100 cases of patients with follicular thyroid carcinoma and 100 healthy subjects as controls,computing the susceptibility of chromogranin A(CGA)in diagnosis of thyroid cancer.compare the differences of the concentration of plasma CGA in different thyroid tumor tissue,and calculate its sensitivity to different types of thyroid cancer diagnosis.Simultaneously,we can evaluate the differences of serum CGA in metastasis and non-metastasis patients of medullary thyroid cancer,also,before and after surgery.ResultsIt has statistically significant difference in the comparison of serum CGA between the four groups(P <0.05).CGA in medullary thyroid carcinoma group was significantly higher than the healthy control group,benign thyroid nodules,follicular thyroid carcinoma and papillary thyroid carcinoma,and there is significant difference(P <0.001).The sensitivity of serum CGA in the diagnosis of medullary thyroid carcinoma is 49%.All patients with medullary thyroid cancer must undergo surgery.comparing the serum CGA in the two groups before and after surgery,we found that serum CGA levels were reduced accordingly,after surgical treatment of medullary thyroid carcinoma.And two sets of data have significant difference(P<0.001).For patients with medullary thyroid carcinoma metastasis has occurred,serum CGA concentration was significantly higher than nonmetastasis group(P <0.001).ConclusionAt the present,CGA is not considered to be the first choice marker of thyroid cancer.However,serum CGA still has some significance in diagnosis of medullary thyroid cancer that are either not able to secrete hormonal products,for example,calcitonin,or release products that cannot be detected by current techniques.Serum CGA can also act as dynamic mo-nitorring and prognostic indicators in tumor development process,monitoring tumor prog-ression and metastasis.