The Diagnostic Value of Calcitonin Measurement in Wash-out Fluid from Fine-Needle Aspiration of Thyroid Nodules in the Diagnosis of Medullary Thyroid Cancer |
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| Institution: | 1. Department of Biomedical, Metabolic and Neural Sciences, Unit and Chair of Endocrinology and Metabolism Modena, Italy;2. Integrated Department of Medicine, Endocrinology and Metabolism, Geriatrics, University of Modena and Reggio Emilia, Azienda AUSL of Modena, NOCSAE of Baggiovara, Modena, Italy;3. Unit of Diabetology, Azienda USL of Modena, Modena, Italy;4. Department of Clinical Pathology, Azienda USL of Modena, NOCSAE of Baggiovara, Modena, Italy;1. Internal Medicine Department, Carlos Haya Hospital, Malaga, Spain;2. CIBER Fisiopatologia de la Obesidad y la Nutricion (CB06/003), Malaga, Spain;3. Preventive Medicine Department, Malaga University, Malaga, Spain;4. Health Center “Ciudad Jardin,” Malaga, Spain;5. Research Laboratory, Internal Medicine Department, Carlos Haya Hospital, Malaga, Spain;6. Endocrinology and Nutrition Department, Virgen de la Victoria Hospital, Malaga, Spain;7. Biomedical Research Laboratory, Endocrinology and Nutrition Department, Virgen de la Victoria Hospital, Malaga, Spain;1. Department of Endocrinology, Tan Tock Seng Hospital, Singapore;2. Yong Loo Lin School of Medicine, Singapore;3. Duke-NUS Graduate Medical School, Singapore;4. Brenner Centre for Molecular Medicine, National University of Singapore, Singapore;1. Department of Internal Medicine, Section of Endocrinology, Paris, France;2. Department of Internal Medicine, Paris, France;3. Department of Ophthalmology, Fondation Ophtalmologique A. de Rothschild. Paris, France.;1. Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York;2. Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York;3. Division of Pediatric Otolaryngology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;4. Department of Radiology, Jacobi Medical Center, Bronx, New York.;1. Minnesota Center for Obesity, Metabolism, and Endocrinology (MNCOME);2. Center for Nutrition and Metabolism, Division of Endocrinology, Nutrition, and Metabolism, Department of Internal Medicine, University of Nevada School of Medicine, Reno, Nevada;3. Internist and Clinical Research Physician specializing in diabetes during pregnancy, Sansum Diabetes Research Institute;4. Director of Endocrinology, Minnesota Center for Obesity, Metabolism, and Endocrinology (MNCOME);5. Division of Endocrinology, Diabetes, Metabolism, Nutrition, College of Medicine, Mayo Clinic;6. CEO and Chief Scientific Officer, Sansum Diabetes Research Institute;7. Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York;8. Bone Densitometry Unit and Osteoporosis Center, Texas Institute for Reproductive Medicine and Endocrinology;9. Weight Loss and Diabetes Center, Endocrinology, Northeast Medical Group, Greenwich Hospital/Yale New Haven Health and Clinical Associate Professor of Medicine, Drexel University College of Medicine;10. Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University;11. Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University;12. Northwestern University Feinberg School of Medicine, Chicago, Illinois;13. Center for Nutrition and Metabolism, Division of Endocrinology, Nutrition, and Metabolism, Department of Internal Medicine, University of Nevada School of Medicine, Reno, Nevada;14. Assistant Clinical Professor of Medicine, Center for Nutrition and Metabolism, Division of Endocrinology, Nutrition, and Metabolism, Department of Internal Medicine, University of Nevada School of Medicine, Reno, Nevada, and Adjunct Associate Professor of Endocrinology and Internal Medicine, Touro University Nevada, College of Osteopathic Medicine;15. Center for Nutrition and Metabolism, Division of Endocrinology, Nutrition, and Metabolism, Department of Internal Medicine, University of Nevada School of Medicine, Reno, Nevada;16. University of Pennsylvania School of Medicine, Department of Psychiatry, Center for Weight and Eating Disorders;17. Center for Nutrition and Metabolism, Division of Endocrinology, Nutrition, and Metabolism, Department of Internal Medicine, University of Nevada School of Medicine, Reno, Nevada.;1. Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut;2. Department of Pediatrics, College of Medicine of Peoria, University of Illinois |
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| Abstract: | ObjectiveThe diagnostic value of calcitonin measurement in fine-needle aspiration biopsy (FNAB) washout fluid (Ct-FNAB) for medullary thyroid cancer (MTC) remains to be determined. This prospective study aimed to assess the diagnostic value of Ct-FNAB in thyroid nodules in comparison with basal serum calcitonin (Ct), pentagas- trin-stimulated Ct (Pg-sCt), and cytology.MethodsAmong patients with goiter addressed with US-FNAB who had an initial clinical suggestion for thyroidectomy, 27 patients with thyroid nodule/s (n = 60) and normal, borderline, or increased Ct fulfilled the criteria for thyroidectomy. All 27 patients (enrolled according to exclusion/inclusion criteria) underwent ultrasonography (US), Ct, Pg-sCt, US-assisted FNAB of each patient’s nodule for both cytology, and Ct-FNAB before thyroidectomy.ResultsCt-FNAB always resulted in >1,000 pg/mL in MTC nodules at histology. For values between 36 and pg/mL, MTCs and nodular or micronodular C-cell hyperplasia (CCH) results overlapped. Most of the nodules without MTC and/or CCH had Ct-FNAB <17 pg/mL. Ct-FNAB diagnostic power was superior to and similar to other diagnostic procedures (Ct, Pg-sCt, and cytology) in identifying both MTC and CCH, and MTC alone, respectively.ConclusionThe diagnostic power of Ct-FNAB is valuable compared with other routine procedures. Ct-FNAB is highly reliable for the early detection and accurate localization of MTC in thyroid nodules, but it does not differentiate between MTC and CCH. Ct-FNAB is an extremely valuable diagnostic tool, especially considering that other diagnostic procedures do not provide a definitive diagnosis, and it can be included in the clinical work-up of thyroid nodules when MTC is suspected. (Endocr Pract. 2013;19:769-779) |
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