Is there a place for measuring serum calcitonin prior to thyroidectomy in patients with a non-diagnostic thyroid nodule biopsy?

Diego Henrique Andrade De Oliveira,Luiz Pierre Huning,Patrick Fontes Rodrigues,Hans Graf,Hildebrando Massahiro Nagai,Mariana Comiran Belim

doi:10.20945/2359-3997000000320

Abstract

To verify the cytopathological Bethesda System classification of thyroid nodule fine-needle aspiration biopsy (FNAB) in MTC patients and to assess the role of preoperative serum calcitonin (CT) levels in the investigation of this neoplasm in medullary thyroid cancer (MTC) patients under observation at the Uopeccan (União Oeste Paranaense de Estudos e Combate ao Câncer). This is a cross-sectional review of medical records of patients monitored at the thyroid cancer outpatient clinic of Uopeccan. Clinical and demographic data, laboratory tests, ultrasound images, and cytopathological findings of MTC patients were evaluated. Among the 360 patients with thyroid cancer monitored in the outpatient clinic, 5.2% (n: 19/360) had MTC. The hereditary form was more prevalent (63.2%), and there was no sex preference. The most common ultrasound findings were hypoechogenicity, solid appearance and microcalcifications. The FNAB diagnoses showed a sensitivity of 47.1%, and the most common cytopathological report was Bethesda category III. Serum CT levels showed good sensitivity (84.6%) for the diagnosis of MTC, and sensitivity levels were directly associated with the size of the nodule and distant metastases. Bethesda category III was more prevalent in this group of MTC patients. Serum CT levels were more sensitive than cytopathology for diagnosis of this neoplasm and were able to identify all patients who could not be diagnosed by FNAB.

Highlights

Medullary thyroid cancer (MTC) is a welldifferentiated neuroendocrine carcinoma that affects thyroid C-cells
The few studies that analyzed ultrasound images of MTC patients found that the traditional risk factors used to characterize papillary thyroid carcinoma (PTC) are similar to those for MTC [5]
We identified 360 patients with thyroid cancer who were under follow-up at the Uopeccan outpatient clinic

Summary

Introduction

Medullary thyroid cancer (MTC) is a welldifferentiated neuroendocrine carcinoma that affects thyroid C-cells It represents approximately 5% of malignant thyroid nodules and is an aggressive neoplasm with an estimated 10-year survival rate of 40%-50% [1]. MTC occurs in the sporadic form in 80% of cases, with the remaining 20% caused by an autosomal dominant genetic disorder associated with mutations in the RET gene [3]. The distinction between these forms is of particular clinical relevance due to differences in prognosis and the need for family screening, genetic counseling, and follow-up for hereditary forms [4]. The few studies that analyzed ultrasound images of MTC patients found that the traditional risk factors used to characterize papillary thyroid carcinoma (PTC) are similar to those for MTC [5]

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Conclusion