Fine Needle Aspiration and Medullary Thyroid Carcinoma: The Risk of Inadequate Preoperative Evaluation and Initial Surgery when Relying upon Fnab Cytology Alone

Essig, Garth; Porter, Kyle; Schneider, David; Arpaia, Debora; Lindsey, Susan C.; Busonero, Giulia; Fineberg, Daniel; Fruci, Barbara; Boelaert, Kristien; Smit, Johannes; Meijer, Johannes Arnoldus Anthonius; Duntas, Leonidas H.; Sharma, Neil; Costante, Giuseppe; Filetti, Sébastiano; Sippel, Rebecca S.; Biondi, Bernadette; Topliss, Duncan J.; Pacini, Furio; Maciel, Rui M. B.; Walz, Patrick C.; Kloos, Richard T.

doi:10.4158/ep13143.or

Cited by 88 publications

(64 citation statements)

References 33 publications

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“…FNA cytology for a diagnosis of MTC has been proved to have a low sensitivity of 43.7% in recent multicenter and international studies. 10 It has been reported with a wide range from 30% to 89% in smaller series. 11,13,21,22 Its low sensitivity leads to the misdiagnosis of MTC and negatively impacts patient management in several ways.…”

Section: Discussionmentioning

confidence: 95%

“…Although fine-needle aspiration (FNA) cytology is an important diagnostic tool for evaluating thyroid nodules, its low sensitivity for diagnosing MTC limits an optimal preoperative evaluation and an operation in approximately half of the patients. 10,11 Serum calcitonin level measurement in patients with thyroid nodules is a sensitive and specific marker with even better diagnostic accuracy than cytology in unsuspected MTC, though the routine measurement of serum calcitonin levels in nodular thyroid disease and the cutoff value for a diagnosis of MTC are still debatable. [11][12][13] Due to these diagnostic difficulties, some MTC is still incidentally discovered after a diagnostic operation or after an operation with an incorrect presurgical diagnosis-this situation presents the risk of an incomplete therapeutic approach and a less favorable prognosis.…”

mentioning

confidence: 99%

“…[11][12][13] Due to these diagnostic difficulties, some MTC is still incidentally discovered after a diagnostic operation or after an operation with an incorrect presurgical diagnosis-this situation presents the risk of an incomplete therapeutic approach and a less favorable prognosis. 10,14,15 Therefore, early and accurate diagnosis of MTC is of crucial importance for optimal management. We studied core needle biopsy (CNB) for the diagnosis of MTC at 3 medical institutions during a 10-year period.…”

mentioning

confidence: 99%

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The Role of Core Needle Biopsy and Its Impact on Surgical Management in Patients with Medullary Thyroid Cancer: Clinical Experience at 3 Medical Institutions

Baek

et al. 2015

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

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confidence: 99%

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The Role of Core Needle Biopsy and Its Impact on Surgical Management in Patients with Medullary Thyroid Cancer: Clinical Experience at 3 Medical Institutions

Baek

et al. 2015

AJNR Am J Neuroradiol

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“…The sensitivity of FNAB for diagnosing MTC in a thyroid nodule varies from 46.1-63% (17-19) (B). Although non-diagnostic, the FNAB findings in MTC are indicative of surgery in 99% of cases (17)(18)(19)) (B). Approximately 82% of MTC cases are correctly identified by FNAB, while 9% are false-negative results (18,19) (B).…”

Section: Recommendationmentioning

confidence: 99%

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

Maia

Siqueira

Kulcsar

et al. 2014

Arq Bras Endocrinol Metab

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Introduction: Medullary thyroid carcinoma (MTC) originates in the thyroid parafollicular cells and represents 3-4% of the malignant neoplasms that affect this gland. Approximately 25% of these cases are hereditary due to activating mutations in the REarranged during Transfection (RET) proto-oncogene. The course of MTC is indolent, and survival rates depend on the tumor stage at diagnosis. The present article describes clinical evidence-based guidelines for the diagnosis, treatment, and follow-up of MTC. Objective: The aim of the consensus described herein, which was elaborated by Brazilian experts and sponsored by the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism, was to discuss the diagnosis, treatment, and follow-up of individuals with MTC in accordance with the latest evidence reported in the literature. Materials and methods: After clinical questions were elaborated, the available literature was initially surveyed for evidence in the MedLine-PubMed database, followed by the Embase and Scientific Electronic Library Online/Latin American and Caribbean Health Science Literature (SciELO/Lilacs) databases. The strength of evidence was assessed according to the Oxford classification of evidence levels, which is based on study design, and the best evidence available for each question was selected. Results: Eleven questions corresponded to MTC diagnosis, 8 corresponded to its surgical treatment, and 13 corresponded to follow-up, for a total of 32 recommendations. The present article discusses the clinical and molecular diagnosis, initial surgical treatment, and postoperative management of MTC, as well as the therapeutic options for metastatic disease. Conclusions: MTC should be suspected in individuals who present with thyroid nodules and family histories of MTC, associations with pheochromocytoma and hyperparathyroidism, and/or typical phenotypic characteristics such as ganglioneuromatosis and Marfanoid habitus. Fine-needle nodule aspiration, serum calcitonin measurements, and anatomical-pathological examinations are useful for diagnostic confirmation. Surgery represents the only curative therapeutic strategy. The therapeutic options for metastatic disease remain limited and are restricted to disease control. Judicious postoperative assessments that focus on the identification of residual or recurrent disease are of paramount importance when defining the follow-up and later therapeutic management strategies. Arq Bras Endocrinol Metab. 2014;58(7):667-700

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“…Minimally, or even moderately, elevated serum concentrations of Ct may not distinguish MTC from other benign conditions [1][2][3][4][5][6][7][8][9]. Fineneedle biopsy (FNB) of thyroid nodules is commonly used for malignancy evaluation [9][10][11][12][13][14][15][16][17][18]. The majority of previously published reports indicate that FNB has relatively low sensitivity [5,7,9,[13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Modified Fine-Needle Aspiration Biopsy for Calcitonin, Procalcitonin and Carcinoembryonic Antigen Levels in the Diagnosis of Thyroid Nodules With Medullary Thyroid Carcinoma

et al. 2017

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Fine Needle Aspiration and Medullary Thyroid Carcinoma: The Risk of Inadequate Preoperative Evaluation and Initial Surgery when Relying upon Fnab Cytology Alone

Cited by 88 publications

References 33 publications

The Role of Core Needle Biopsy and Its Impact on Surgical Management in Patients with Medullary Thyroid Cancer: Clinical Experience at 3 Medical Institutions

The Role of Core Needle Biopsy and Its Impact on Surgical Management in Patients with Medullary Thyroid Cancer: Clinical Experience at 3 Medical Institutions

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

Modified Fine-Needle Aspiration Biopsy for Calcitonin, Procalcitonin and Carcinoembryonic Antigen Levels in the Diagnosis of Thyroid Nodules With Medullary Thyroid Carcinoma

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