Standards, Options and Recommendations for tumor markers in thyroid cancers

Context: The "Standards, Options and Recommendations" (SOR) project, starte d in 1993, is a collaboration between the Federation of the French Cancer C enters (FNCLCC), the 20 French Cancer Centers and specialists from French P ublic Universities, General Hospitals and Private Clinics. The main objecti ve is the development of clinical practice guidelines to improve the qualit y of health care and outcome-for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. Objective s: To define, according to the definitions of the Standards, Options and Re commendations project, the characteristics of the main tumor markers in thy roid cancer and the potential role of these markers in the management of pa tients with this malignancy. Methods: Data were identified hy searching Med line (R) and the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to 55 independent reviewers, and to the medical committees of the 20 French Ca ncer Centers. Results: The main recommendations are: 1) Thyroglobulin is a serum tumor marker for the monitoring of operated thyroid differentiated ne oplasms (standard). 2) It is essential to know if the patient is under TSH stimulation or under thyroid suppression therapy to interpret thyroglobulin results (standard). 3) Thyroglobulin assay must be performed regularly dur ing the monitoring of differentiated thyroid neoplasms (standard, level of evidence B2), should be coupled with the measurement Of anti-thyroglobulin antibodies concentration using a sensitive method (standard level of eviden ce B2). 4) Thyroglobulin assay should not be performed to detect or diagnos e differentiated thyroid neoplasms (standard, level of evidence B2). 5) The methods used to assay thyroglobulin must have a limit of detection lower t han 3 mug.l(-1) (standard, expert agreement). 6) Calcitonin is a marker for medullary thyroid cancer (standard). 7) Its assay, associated with RET gen e study if indicated, enables medullary thyroid cancer to be diagnosed 8) T he pentagastrin test is essential to diagnose familial forms of medullary t hyroid cancer. 9) All analyses for each patient must be performed in the sa me laboratory, using the same technique (standard, expert agreement). 10) C alcitonin and carcinoembryonic-antigen are serum markers for the monitoring of medullary thyroid cancer and allow the detection of recurrent disease ( standard).