Abstract
Widespread use of sensitive ultrasound examination led to an increasing detection of medullary thyroid microcarcinoma (micro-MTC). This prospective study evaluated the diagnostic accuracy of Fine-needle Aspiration Biopsy Cytology (FNAB-C) and calcitonin assay in Fine-needle Aspiration Biopsy wash-out fluid (FNAB-CT) in thyroid nodules less than 1 cm with elevated serum calcitonin(sCT). 87 thyroid nodules from 60 patients with elevated sCT (>10 pg/ml) were included and 51 were thyroid nodules less than 1cm. FNAB-CT and FNAB-C were performed to distinguish medullary thyroid carcinoma (MTC) lesions before surgery, histopathologic diagnoses served as main reference standards. FNAB-CT had a greater performance over FNAB-C for preoperative diagnosis of MTC (diagnostic accuracy: 98.85 vs 61.90%, sensitivity: 98.55 vs 55.07%, specificity: 100 vs 97.44%), especially for micro-MTC: FNAB-C established a sensitivity and diagnostic accuracy of 48.78 and 58% respectively, while FNAB-CT reached 97.56% sensitivity and 98.04% diagnostic accuracy. FNAB-CT demonstrated high diagnostic accuracy in diagnosing micro-MTC. Patients with microscopic thyroid nodules and elevated sCT level should perform FNAB-CT to exclude the diagnosis of MTC lesions.
Highlights
FNAB-CT had a greater performance over Fine-needle Aspiration Biopsy Cytology (FNAB-C) for preoperative diagnosis of Medullary thyroid carcinoma (MTC), especially for micro-MTC: FNAB-C established a sensitivity and diagnostic accuracy of 48.78% and 58% respectively, while FNAB-CT reached 97.56% sensitivity and 98.04% diagnostic accuracy
Patients with micro thyroid nodules and elevated Serum calcitonin (sCT) level should perform FNAB-CT to exclude the diagnosis of MTC lesions
Medullary thyroid carcinoma (MTC) is a neuroendocrine malignancy originated from the calcitonin (CT)-secreting parafollicular C cells, which accounts for ~2% of all malignant thyroid neoplasms and 13.4% of the total deaths attributable to thyroid cancer [1]
Summary
Medullary thyroid carcinoma (MTC) is a neuroendocrine malignancy originated from the calcitonin (CT)-secreting parafollicular C cells, which accounts for ~2% of all malignant thyroid neoplasms and 13.4% of the total deaths attributable to thyroid cancer [1]. The routine use of sensitive ultrasound enabled the early detection of micro thyroid carcinoma and retrospective analyses suggested an increasing trend in the proportion of micro-MTC in recent decades [2,3,4,5,6]. Serum calcitonin(sCT) level generally rises early in MTC patients and parallels with tumor progression. As tumor size significantly correlates with preoperative sCT levels, patients with micro-MTC usually have an“indeterminate” elevated basal sCT(10-100pg/ml) , making it difficult to distinguish early stage MTC from other physiological and pathological conditions [8, 14, 15]. One recent study found no superiority of the stimulation test in early diagnosis of MTC due to the improved sensitivity of sCT assay [17]. Thereby, the ability of sCT to command an optimal preoperative evaluation for micro-MTC, is limited
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