Calcitonin assay in wash-out fluid after fine-needle aspiration biopsy in patients with a thyroid nodule and border-line value of the hormone

Abstract

Assaying calcitonin (CT) in the wash-out fluid from fine-needle aspiration biopsies (CT-FNAB) could be useful in the diagnosis of medullary thyroid carcinoma (MTC). The aim of this study was to correlate serum CT with cytology and CT-FNAB. Twenty-seven subjects (age range 27-75 yr) were studied. FNAB was performed in a thyroid nodule (no.=16) or lymph-node (no.=1 previously operated on for MTC) or in the prevalent nodule of multinodular goiters (no.=10). CT-FNAB values obtained in 37 subjects with normal serum CT (<10 ng/l) who underwent FNAB for thyroid nodules served as a negative control. In these subjects, CTFNAB values were 8.2+/-6.4 ng/l (range 2-30 ng/l). In patients with a thyroid nodule under evaluation for MTC, serum CT and CT-FNAB values were 14.5+/-3.9 ng/l (range 10-24 ng/l) and 16.4+/-29.8 ng/l (range 2-144 ng/l), respectively. In 4 patients, CT-FNAB values were higher than the highest values found in our negative controls (30 ng/l), but cytology results were compatible with a benign thyroid lesion and pentagastrin testing was negative. In 3 cases with CT-FNAB <30 ng/l, cytology was indicative of an indeterminate or probably follicular malignant lesion and histology was negative for MTC. None of the other subjects in whom pentagastrin testing was conducted showed serum CT values >100 ng/l. Our data do not show any correlation between CT-FNAB and serum CT. In conclusion, borderline CT values in patients with thyroid nodules are not rare. Our experience suggests that CT-FNAB does not have the same importance as that reported in the literature for thyroglobulin and PTH assay in wash-out fluid after FNAB in malignant thyroid and hyperfunctioning parathyroid lesions.

Is there a real diagnostic impact of elastosonography and contrast-enhanced ultrasonography in the management of thyroid nodules?

“…Auto-antibodies against thyroperoxidase (TPOAb) were evaluated by means of the Dia Sorin assay (Saluggia, Italy); concentrations <100 mIU/L were regarded as negative. Serum calcitonin (CT) was assayed by chemiluminescence immunoassay (Dia Sorin); in our laboratory, the upper limit of the normal CT range is <10 ng/L; our institutional cut-off for CT evaluation in needle washing after FNAB is 30 ng/L (Massaro et al, 2009). …”

Thyroid nodules in pediatrics: which ones can be left alone, which ones must be investigated, when and how

“…This method, previously employed for the early detection of cervical metastases following thyroidectomy and radioiodine therapy, allows an early diagnosis of lymph node metastases before surgery and is mostly employed in cases with small thyroid nodules but with enlarged lymph nodes that are highly suggestive of malignancy (52,53,54). Assessment of calcitonin level in the washout fluid from FNAB of cervical lymph nodes can also be used as a potentially highly reliable diagnostic procedure to identify primary and recurrent/metastatic MTC (52,54,55).…”

Medullary thyroid cancer diagnosis: An appraisal

“…C cells produce calcitonin and the measurement of calcitonin in needle washout after biopsy is helpful in localizing MTC. The few articles that evaluated the role of FNA‐calcitonin for the diagnosis of MTC consistently showed that FNA‐calcitonin has a high accuracy …”