{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T18:34:40Z","timestamp":1790015680625,"version":"4.0.1"},"reference-count":30,"publisher":"The Endocrine Society","issue":"3","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Current guidelines recommend performing preoperative additional imaging in patients with medullary thyroid cancer (MTC) when calcitonin levels exceed 500\u2005pg\/mL to detect distant metastases (M1). However, this recommendation is based on limited evidence. Whether this is the optimal cutoff, including other diagnostic characteristics, has only been partially evaluated in research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The aims of this study were to evaluate the current calcitonin-driven recommendation and to investigate whether other diagnostic characteristics can be added to improve prediction of M1 disease at diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adult MTC patients treated in a tertiary care hospital between 1984 and 2023 with a preoperative calcitonin measurement were retrospectively collected. M1 disease was detected by preoperative imaging or biopsy. Logistic regression was used to identify new predictors for M1 at diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 81 patients with MTC were included for analysis. M1 disease at presentation was found in 27%. Sensitivity and specificity for the current calcitonin cutoff were 90.9% (95% CI, 72.2-97.5) and 47.5% (95% CI, 35.3-60.0), respectively. In multivariable analysis, presence of suspicious lymph nodes on preoperative ultrasound was the strongest predictor (odds ratio [OR] 6.7; 95% CI, 1.3-34.2; P = .022) followed by calcitonin (OR 1.9; 95% CI, 1.2-2.8; P = .005) for M1 disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>To our knowledge, this is the first study investigating the optimal combination of predictors for M1 disease in MTC at diagnosis. Suspicious lymph nodes on ultrasound is the strongest predictor for M1 disease, well exceeding calcitonin levels. Incorporating suspicious lymph nodes and calcitonin into a novel clinical decision tool may optimize M1 detection while reducing unnecessary imaging.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/jendso\/bvag002","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T12:42:42Z","timestamp":1767789762000},"source":"Crossref","is-referenced-by-count":2,"title":["Prediction of distant metastases at diagnosis in medullary thyroid cancer: combining calcitonin with lymph node imaging"],"prefix":"10.1210","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7777-8609","authenticated-orcid":false,"given":"Leonoor E","family":"Schonebaum","sequence":"first","affiliation":[{"name":"Academic Center for Thyroid Disease, Department of Internal Medicine, Erasmus Medical Center , Rotterdam 3015 CE ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hossein","family":"Razaghi Siahroudi","sequence":"additional","affiliation":[{"name":"Academic Center for Thyroid Disease, Department of Internal Medicine, Erasmus Medical Center , Rotterdam 3015 CE ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7855-5418","authenticated-orcid":false,"given":"Layal","family":"Chaker","sequence":"additional","affiliation":[{"name":"Academic Center for Thyroid Disease, Department of Internal Medicine, Erasmus Medical Center , Rotterdam 3015 CE ,","place":["The Netherlands"]},{"name":"Department of Epidemiology, Erasmus University Medical Center , Rotterdam 3015 CE, The \u00a0","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5937-7505","authenticated-orcid":false,"given":"Sjoerd A A","family":"van den Berg","sequence":"additional","affiliation":[{"name":"Diagnostic Laboratory for Endocrinology, Department of Internal Medicine, Erasmus Medical Center , Rotterdam 3015 CE ,","place":["The Netherlands"]},{"name":"Department of Clinical Chemistry, Erasmus Medical Center , Rotterdam 3015 CE ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9365-4892","authenticated-orcid":false,"given":"Tessa M","family":"van Ginhoven","sequence":"additional","affiliation":[{"name":"Academic Center for Thyroid Disease, Department of Oncological Surgery, Erasmus Medical Center Cancer Center , Rotterdam 3015 CE ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7732-9371","authenticated-orcid":false,"given":"Robin P","family":"Peeters","sequence":"additional","affiliation":[{"name":"Academic Center for Thyroid Disease, Department of Internal Medicine, Erasmus Medical Center , Rotterdam 3015 CE ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5248-863X","authenticated-orcid":false,"given":"W Edward","family":"Visser","sequence":"additional","affiliation":[{"name":"Academic Center for Thyroid Disease, Department of Internal Medicine, Erasmus Medical Center , Rotterdam 3015 CE ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2026,1,8]]},"reference":[{"issue":"4","key":"2026030511563949600_bvag002-B1","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1530\/ERC-15-0445","article-title":"Recent incidences and differential trends of thyroid cancer in the USA","volume":"23","author":"Mao","year":"2016","journal-title":"Endocr Relat Cancer"},{"issue":"13","key":"2026030511563949600_bvag002-B2","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1001\/jama.2017.2719","article-title":"Trends in thyroid cancer incidence and mortality in the United States, 1974-2013","volume":"317","author":"Lim","year":"2017","journal-title":"JAMA"},{"issue":"3","key":"2026030511563949600_bvag002-B3","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1046\/j.1365-2265.1998.00392.x","article-title":"Prognostic factors for survival and for biochemical cure in medullary thyroid carcinoma: results in 899 patients. 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