Ultrasound features of medullary thyroid carcinoma correlate with cancer aggressiveness: a retrospective multicenter study.

Pierpaolo Trimboli,Luca Giovanella,Agnese Barnabei,Marialuisa Appetecchia,Roberto Baldelli,Nadia Cremonini,Roberto Negro,Stefano Valabrega,Anna Crescenzi,Massimiliano Andrioli,Claudio Ventura,Fabio Orlandi,Vito Cantisani,Giorgio Fattorini,Leo Guidobaldi,Enrico Saggiorato,Maurizio Latini,Francesco Romanelli,Fábio Henrique Rossi ,F Dambrosio ,P Falasca ,Francesca Silvia Rota ,Laura Rizzà ,A Paoloni

doi:10.1186/s13046-014-0087-4

Abstract

BackgroundPoor prognosis of medullary thyroid cancer (MTC) with suspicious ultrasound (US) features has been reported. The aim of the study was to investigate the association between preoperative US presentation and aggressiveness features of MTC. Also, US features of MTC were compared with those previously reported.MethodsStudy group comprised 134 MTC from nine different centers. Based on US presentation the nodules were stratified in “at risk for malignancy” (m-MTC) or “probably benign” (b-MTC) lesions.ResultsEighty nine (66.4%) m-MTC and 45 (33.6%) b-MTC were found. Metastatic lymph nodes (p = 0.0001) and extrathyroid invasiveness (p < 0.0001) were more frequent in m-MTC. There was statistically significant correlation (p = 0.0002) between advanced TNM stage and m-MTC with an Odds Ratio 5.5 (95% CI 2.1–14.4). Mean postsurgical calcitonin values were 224 ± 64 pg/ml in m-MTC and 51 ± 21 in b-MTC (p = 0.003).ConclusionsThis study showed that sonographically suspicious MTC is frequently associated with features of aggressiveness, suggesting that careful preoperative US of MTC patients may better plan their surgical approach.

Highlights

Medullary thyroid cancer (MTC) originates from thyroid C cells and accounts for about 5% of thyroid malignancy [1]
The diagnosis of medullary thyroid cancer (MTC) represents a diagnostic challenge in clinical practice
The preoperative diagnosis had been based on high serum calcitonin levels with a suggestive cytology and/or detection of calcitonin in fine needle aspiration washout [13,14,15]

Summary

Introduction

Medullary thyroid cancer (MTC) originates from thyroid C cells and accounts for about 5% of thyroid malignancy [1]. MTC may occur as sporadic tumor (about 80% of cases) or be part of a familial disorder [1]. The diagnosis of MTC represents a diagnostic challenge in clinical practice. Fine needle aspiration (FNA) of thyroid nodules has several pitfalls for this histologic type. The cytologic examination can diagnose MTC with classical presentation, and the detection rate was reported of 56% in a recent meta-analysis [2]. Poor prognosis of medullary thyroid cancer (MTC) with suspicious ultrasound (US) features has been reported. The aim of the study was to investigate the association between preoperative US presentation and aggressiveness features of MTC. US features of MTC were compared with those previously reported

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