Procalcitonin as an alternative tumor marker of medullary thyroid carcinoma. A meta-analysis

Objective This study aimed to determine the procalcitonin (ProCT) diagnostic accuracy in prediction and treatment monitoring of medullary thyroid carcinoma (MTC). Data Sources Electronic databases were searched for observational studies published until May 2021 without language or time restrictions. Study Selection Studies comparing ProCT and calcitonin accuracy were included. After removing duplicates and exclusion of not-eligible articles, relevant articles were screened independently by two reviewers. Eleven studies (4.5% of the identified studies) met the selection criteria. Data Extraction Two reviewers independently extracted data and assessed data quality and validity through QUADAS-2. Data Synthesis A meta-analysis was performed on sufficiently clinically and statistically homogeneous eleven studies (n = 5817 patients, 335 MTC patients). HSROC and bivariate methods were applied. Serum ProCT was found to be a highly accurate test for MTC diagnosis and monitoring. The pooled sensitivity, specificity, positive and negative likelihood ratios, AUC, and positive and negative predictive values for ProCT were 0.90 (95%CI: 0.71-0.97), 1.00 (95%CI: 0.85-1.00), 288 (95%CI: 5.6-14929.3), 0.10 (95%CI: 0.03-0.33), 0.97 (95%CI: 0.95-0.98), 99% and 2%. Conclusions The high accuracy, compounded with favorable analytical characteristics, give ProCT great potential to replace calcitonin as a new standard of care in the management of MTC.