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

Abstract

Objective: 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). Materials and methods: 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. Results and discussion: 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. Conclusion: 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.

The value of routine measurement of serum calcitonin on insufficient, indeterminate, and suspicious thyroid nodule cytology

“…Calcitonin measurement helped diagnosis in 1 of 427 cases with AUS/FLUS cytology, and indicated MTC in 2 of 73 cases with FN/SFN cytology. An indeterminate cytology result was found at the rate of 0-30% in the previous studies investigating the FNAB results of large medullary cancer case series, which was similar to the current case series [ 4 , 18 , 33 ]. While routine calcitonin measurement seems to be reasonable in cases with FN/SFN, in cases with multiple AUS cytology, instead of routine calcitonin measurement, calcitonin can be screened particularly in patients with suspicious features of MTC on ultrasonography or with a family history of MTC [ 6 ].…”

“…Measurement of serum calcitonin is a sensitive and specific marker in the diagnosis and follow-up of MTC [ 13 , 15 ] and it is well known that the most important factor in MTC prognosis is early diagnosis of the disease [ 13 , 16 ]. Calcitonin measurement has been shown to be superior to FNAB in MTC detection in the previous studies [ 4 , 17 , 18 ] Nevertheless, routine calcitonin measurement in nodular thyroid disease is controversial. Although the detection of MTC through routine calcitonin screening has recently been shown to lead to early stage diagnosis, the ATA guideline did not make recommendations for routine calcitonin measurement in nodular thyroid patients, leaving the decision up to the clinicians [ 13 ].…”

Suboptimal accuracy of ultrasound and ultrasound‐based risk stratification systems in detecting medullary thyroid carcinoma should not be overlooked. Findings from a systematic review with meta‐analysis

“…The 25 articles 19–43 found according to the criteria of the present systematic review were published between 2002 and 2021. The authors were from eastern countries in 18 papers, European in five, and American in two.…”

“…Finally, 25 studies could be included in the systematic review (Figure 1 ). 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 …”

Post-thyroidectomy hypocalcemia and related complications

“…Del Rio, Rico, Bordiu, & Novoa, 1987). Oliveira et al,( 2021) detected a reduction in calcitonin levels after thyroidectomy (Oliveira et al, 2021). Qu et al, (2022), (Tinawi, 2021) andCornelius, (2020) suggested that hypoalbuminemia may be the main factor in the pathogenesis of postoperative hypocalcemia, when only total calcium is measured.…”