Abstract
Background. There is a current debate in the medical literature about plasma calcitonin screening in patients with nodular goiter (NG). We decided on analyzing our 20-year experience with patients in an iodine-deficient region (ID). Patients and Methods. 22,857 consecutive patients with NG underwent ultrasonography and aspiration cytology (FNAC). If FNAC raised suspicion of medullary cancer (MTC), the serum calcitonin was measured. Results. 4,601 patients underwent surgery; there were 23 patients among them who had MTC (0.1% prevalence). Significantly more MTC cases were diagnosed cytologically in the second decade than in the first: 11/12 and 6/11, respectively. The frozen section was of help in 2 cases out of 3. Two patients suffered from a 3-year delay in proper therapy, and reoperation was necessary in 1 case. FNAC raised the suspicion of MTC in 20 cases that were later histologically verified and did not present MTC. The diagnostic accuracy of FNAC in diagnosing MTC was 99.2%. Two false-positive serum calcitonin tests (one of them in a hemodialyzed patient) and one false-negative serum calcitonin test occurred in 40 cases. Conclusion. Regarding the low prevalence of MTC in ID regions, calcitonin screening of all NG patients does not only appear superfluously but may have more disadvantages than advantages.
Highlights
Medullary thyroid carcinoma (MTC) is accounted for 3.5– 10% of all thyroid malignancies [1,2,3]; the lesions are derived from the parafollicular C-cells which produce calcitonin [4]
The clinical presentation raised the suspicion of malignancy in 10 of the 23 MTC cases including 1 patient with a benign fine needle aspiration cytology (FNAC) result
The calcitonin level was in the range 8–2,552 pg/Median volume of nodule (mL) with a median level of 277 in 19 preoperatively diagnosed MTC cases
Summary
Medullary thyroid carcinoma (MTC) is accounted for 3.5– 10% of all thyroid malignancies [1,2,3]; the lesions are derived from the parafollicular C-cells which produce calcitonin [4]. There is an ongoing debate in the medical literature about benefits from routine measurement of plasma calcitonin levels in patients who have thyroid nodules [10]. There is a current debate in the medical literature about plasma calcitonin screening in patients with nodular goiter (NG). We decided on analyzing our 20-year experience with patients in an iodine-deficient region (ID). 22,857 consecutive patients with NG underwent ultrasonography and aspiration cytology (FNAC). If FNAC raised suspicion of medullary cancer (MTC), the serum calcitonin was measured. More MTC cases were diagnosed cytologically in the second decade than in the first: 11/12 and 6/11, respectively. Regarding the low prevalence of MTC in ID regions, calcitonin screening of all NG patients does appear superfluously but may have more disadvantages than advantages
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