Lymph Node Metastases of Medullary Thyroid Cancer: Role of Calcitonin in the Washout Fluid of Fine-Needle Aspiration

Marques, Bernardo; Cunha, Nuno; Martins, Raquel G.; Elvas, Ana Rita; Couto, Joana; Santos, Jacinta; Martins, Teresa; Moniz, Ana Paula; Ilheu, Olga; Valido, Frederico; Rodrigues, Fernando

doi:10.1155/2020/9267972

Cited by 11 publications

(13 citation statements)

References 16 publications

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“…As showed by our sub-analysis, the pooled sensitivity of FNA-cytology was negatively influenced by its poor performance in prospective studies; this corroborates that the cytological diagnosis of MTC during the clinical practice is more difficult than its detection when reviewing the cytological specimens for research purpose. Furthermore, the FNA-cytology sensitivity of the most recent studies [ 15 , 16 ] was improved with respect that of the previously published ones; we can speculate that cytopathologists have recently become more aware of this difficult diagnosis and, maybe, have been positively influenced by the concomitant use of FNA-CT. In addition, one study [ 12 ] showed a very poor sensitivity of cytology; this finding might be due to several reasons such as the prospective enrollment of cases and the potential difficult sampling in small nodules (i.e., median size 9.5 mm).…”

Section: Discussionmentioning

confidence: 75%

“…The sensitivity of both FNA-cytology and FNA-CT was reported in all six studies. In addition, some of them [ 14 , 15 ] also calculated the sensitivity of FNA-CT/serum CT ratio. Table 2 illustrates the FNA results recorded in the six studies.…”

Section: Resultsmentioning

confidence: 99%

“…To explore the heterogeneity both study design and date of publication were considered as influencing factors. The FNA-cytology sensitivity was 69% (95% CI 51–87%) in the subgroup of retrospective studies [ 11 , 13 , 15 ] and 39% (95% CI 9–68%) in the subgroup of prospective ones [ 12 , 14 , 16 ]; also, it was 70% (95% CI 42–99%) in the subgroup of most recent studies [ 15 , 16 ] and 45% (95% CI 20–69%) in the subgroup of the previous ones [ 11 – 14 ].

Fig.…”

Section: Resultsmentioning

confidence: 99%

“…According to our searching a number of 204 records was retrieved. After excluding duplicates and applying the above selection criteria, 6 articles [11][12][13][14][15][16] were finally included in the present systematic review (Fig. 1).…”

Section: Articles Retrievedmentioning

confidence: 99%

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Head-to-head comparison of FNA cytology vs. calcitonin measurement in FNA washout fluids (FNA-CT) to diagnose medullary thyroid carcinoma. A systematic review and meta-analysis

et al. 2021

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Purpose The sensitivity of cytology after fine needle aspiration (FNA-cytology) in detecting medullary thyroid carcinoma (MTC) is low. To overcome this problem, measuring calcitonin (CT) in washout fluid of FNA (FNA-CT) has been largely diffused and showed good performance. However, no evidence-based study exists comparing systematically the sensitivity of FNA-cytology and FNA-CT. This study aimed to systematically review the literature and collect data allowing a head-to-head comparison meta-analysis between FNA-cytology and FNA-CT in detecting MTC lesions. Methods The online databases of PubMed/MEDLINE and Scopus were searched until June 2021. Original articles reporting the use of both FNA-cytology and FNA-CT in the same series of histologically proven MTC lesions were included They were extracted general features of each study, number of MTC lesions (nodule and neck lymph nodes), and true positive and false negatives of both FNA-cytology and FNA-CT. Results Six studies were included. The sensitivity of FNA-cytology varied from 20% to 86% with a pooled value of 54% (95% CI 35–73%) and significant heterogeneity. The sensitivity of FNA-CT was higher than 95% in almost all studies with a pooled value of 98% (95% CI 96–100%) without heterogeneity. The sensitivity of FNA-CT was significantly higher than that of FNA-cytology. Conclusions FNA-CT is significantly more sensitive than FNA-cytology in detecting MTC. Accordingly, FNA-CT represents the standard method to use in patients with suspicious MTC lesions, combined with cytology.

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Section: Discussionmentioning

confidence: 75%

Section: Resultsmentioning

confidence: 99%

Fig.…”

Section: Resultsmentioning

confidence: 99%

Section: Articles Retrievedmentioning

confidence: 99%

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Head-to-head comparison of FNA cytology vs. calcitonin measurement in FNA washout fluids (FNA-CT) to diagnose medullary thyroid carcinoma. A systematic review and meta-analysis

et al. 2021

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“…For the detection of MTC, however, FNA sensitivity was only 56.4% in a pooled metanalysis of 15 studies encompassing 641 MTC lesions [13]. More recent studies also show varying sensitivities up to 86% (Table 4) [13,[43][44][45]. In a retrospective review of 61 cases, 16.4% of samples reported low cellularity of the specimen as a limiting factor [43].…”

Section: Fine Needle Aspirationmentioning

confidence: 98%

Diagnostic Challenges of Medullary Thyroid Carcinoma

2021

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Background: Medullary thyroid carcinoma (MTC) comprises 1–2% of all thyroid cancers, yet 15% of all thyroid cancer-related deaths. While up to 20% of cases may be predicted due to autosomal dominant germline mutations, 80% of cases are sporadic. However, due to non-specific presenting symptoms and diagnostic imaging, prompt diagnosis and treatment has remained elusive. This article will further investigate the limitations of MTC diagnosis and look into future areas for diagnostic improvement. Methods: Relevant articles were identified using a systematic PubMed and Google Scholar search. Results: Prophylactic total thyroidectomy for the 20% of MTC cases that are present in autosomal dominant disorder provides definitive treatment. Serum calcitonin (Ctn) screening has several technical limitations due to population variability and laboratory assay interference, but advances in laboratory technology and combined use with fine needle aspiration increase its sensitivity. Other serum assays such as carcinoembryonic antigen and procalcitonin have limited applicability. Thyroid ultrasound remains the gold standard for the initial diagnostic planning, with limited application for CT, MRI, and PET imaging. Conclusion: With complete surgical resection the only definitive treatment, early MTC diagnosis has presented an elusive challenge, mainly due to its relative rarity and difficulty in finding an economic screening strategy. Careful family history combined with fine needle aspiration with serum Ctn analysis can improve diagnostic sensitivity and specificity to greater than 95%.

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An old friend, a new insight: Calcitonin measurement in serum and aspiration needle washout fluids significantly increases the early and accurate detection of medullary thyroid cancer

Ogmen,

Ince,

Aksoy Altınboga

et al. 2023

Cancer Cytopathology

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BackgroundThe sensitivity of cytological (CY) evaluation after fine‐needle aspiration (FNA) for detecting medullary thyroid carcinoma (MTC) is a subject of controversy. The routine use of serum calcitonin (CT) in patients with thyroid nodules is not universally adopted. The authors conducted CT screening of FNA washout fluid (FNA‐CT) to address the diagnostic challenges. The objective was to assess the contributions of serum CT, FNA cytology (FNA‐CY), and FNA‐CT to the diagnosis.MethodsBetween February 2019 and June 2022 (group 1), the authors prospectively screened the CT of patients with thyroid nodules. Both FNA‐CY and FNA‐CT were performed for patients with persistently elevated CT values. The sensitivity of FNA‐CY, serum CT, and FNA‐CT for accurate diagnosis was evaluated. Additionally, the authors retrospectively examined data from patients with thyroid nodules before CT screening (2008–2019) (group 2). They compared the characteristics of MTC patients in groups 1 and 2.ResultsMTC was identified in 30 patients (0.25%) in group 1 and 19 (0.07%) in group 2. A FNA‐CT cutoff value of 4085.5 pg/mL detected MTC with a sensitivity of 96.8%, and a serum CT cutoff value of 28.3 pg/mL detected MTC with a sensitivity of 86.7%. In contrast, FNA‐CY detected MTC with a sensitivity of 42.4%. In group 1, 18 patients (60%) with MTC were diagnosed with microcarcinoma, whereas only two patients (10.5%) in group 2 had microcarcinoma.ConclusionsThis study detected MTC earlier by routinely measuring serum CT in all patients with nodular thyroid disease and performing FNA‐CT in those with elevated values. FNA‐CT and serum CT sensitivities were significantly higher than those of FNA‐CY. This study revealed different FNA‐CT cutoff values compared to other studies, emphasizing the need for determining clinic‐specific cutoff values.

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Lymph Node Metastases of Medullary Thyroid Cancer: Role of Calcitonin in the Washout Fluid of Fine-Needle Aspiration

Cited by 11 publications

References 16 publications

Head-to-head comparison of FNA cytology vs. calcitonin measurement in FNA washout fluids (FNA-CT) to diagnose medullary thyroid carcinoma. A systematic review and meta-analysis

Head-to-head comparison of FNA cytology vs. calcitonin measurement in FNA washout fluids (FNA-CT) to diagnose medullary thyroid carcinoma. A systematic review and meta-analysis

Diagnostic Challenges of Medullary Thyroid Carcinoma

An old friend, a new insight: Calcitonin measurement in serum and aspiration needle washout fluids significantly increases the early and accurate detection of medullary thyroid cancer

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