Calcitonin Measurement in Wash-Out Fluid from Fine Needle Aspiration of Neck Masses in Patients with Primary and Metastatic Medullary Thyroid Carcinoma

Abstract

Objective: The aim of the study was to evaluate the usefulness of calcitonin (CT) assay in fine-needle aspiration biopsy (FNAB) washout fluid alone or combined with cytology in the presurgical study of medullary thyroid carcinoma (MTC) patients with thyroid nodules (TNs) and of suspicious neck MTC recurrences/metastases. Subjects and Methods:A total of 36 ultrasound-guided FNABs were performed in neck masses from 23 patients with borderline or high basal and pentagastrin-stimulated serum CT. Cytology and CT-FNAB were performed on a total of 18 TNs and three neck lymph nodes (LNs) from 12 patients examined before thyroidectomy, and on six suspicious local recurrences (LRs) and nine LNs from nine totally thyroidectomized MTC patients. On the basis of CT-FNAB values found in 15 non-MTC lesions, CT-FNAB more than 36 pg/ml was considered as indicative of MTC.Results: All 21 positive CT-FNAB lesions (10 TNs, six LNs, and five LRs), 13 with positive cytology, were confirmed as MTC at histology. Of the 15 negative CT-FNAB suspicious masses (eight TNs, six LNs, and one LR), five displayed a benign lesion at histology. The remaining 10 cases, all with benign cytology, were not operated on, and no evidence of MTC was detected at follow-up. CT-FNAB reached 100% sensitivity and specificity for MTC, while cytology displayed 61.9% sensitivity and 80% specificity. calcitonin (CT) has been proposed as a routine assay in the diagnostic evaluation of all thyroid nodules (TNs) for early detection of medullary thyroid carcinoma (MTC) (1-4). Fine-needle aspiration cytology represents the main tool in the diagnostic evaluation of TNs, but it is not frequently proposed as a routine procedure in patients with high-serum CT, due to its low sensitivity and specificity (1, 5). Neck ultrasound (US) with color flow Doppler sonography (CFDS) and US-guided fine-needle aspiration cytology is the current diagnostic approach for the identification of MTC neck lymph node (LN) metastases both before and after thyroidectomy (6 -8). A similar approach is used to identify neck recurrences/metastases of differentiated follicular and papillary thyroid carcinoma, where the assay of thyroglobulin (Tg) in fine-needle aspiration biopsy (FNAB) wash-out fluid (Tg-FNAB) represents an additional highly reliable marker (9 -11). When compared with Tg-FNAB, no study has been performed to evaluate the usefulness of CT assay in FNAB (CT-FNAB) fluid alone or combined with cytology. ConclusionsThe aim of this study was to assess the clinical usefulness of CT-FNAB in the identification of primary MTC and its neck LN metastases or recurrences. From 2003From -2006 US-guided FNABs were performed in 23 patients with high-serum CT. These included 21 lesions (18 TNs and three neck LNs) from 14 patients before thyroidectomy and 15 neck masses (six suspicious local recurrences and nine neck LNs) from nine patients after total thyroidectomy for MTC. Patients and Methods Patients studiedAll patients (13 women, age range 36 -76 yr, and 10 men, age range 25-69 yr) were submitted ...

Sporadic hypercalcitoninemia: clinical and therapeutic consequences

“…Boi et al (2007) recommend performing calcitonin measurements in wash-out fluids from fine needle aspiration to improve the diagnosis in primary and metastatic medullary thyroid carcinoma in the work-up thyroid nodules to prevent 'unnecessary' surgery. However, even this modification with fine needle aspiration evaluation may be inconclusive in 'calcitonin screened' patients, because medullary thyroid cancers measured from 0.7 to 7 mm in the group of patients with 'mildly elevated calcitonin levels'.…”

Importance of Hormones and Proteins Determination in the Material Obtained by Fine-Needle Aspiration

“…Although the number of patients was relatively small (27 individuals), these authors concluded that this procedure does not increase fineneedle aspiration's diagnostic value and that its value is considerably lower than determination of PTH in cystic nodes or thyroglobulin in lymph nodes. Consequently, in spite of other studies' findings (70,71), these authors do not recommend measuring calcitonin in thyroid aspirate as a routine method. It is obviously necessary to examine the value of this procedure in larger series and multicentric studies, since it is not possible to collect a sufficient number of samples in one center because of a relatively small prevalence of medullary carcinoma.…”

Diagnóstico, tratamento e seguimento do carcinoma medular de tireoide: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia

“…The measurement of calcitonin in the washout fluid has been recommended to improve the diagnostic sensitivity of FNAB for MTC (22,23) (B/C). In a recent retrospective study, the cytology detected MTC in 21/37 lesions with 56.8% sensitivity whereas the measurement of calcitonin in the washout fluid showed sensitivity and specificity rates of 100% using a cutoff of 36 pg/mL (24) (B).…”