Diagnostic tests for medullary thyroid carcinoma: an umbrella review

Abstract

Purpose To summarize the more robust evidence about the performance of tools useful for diagnosis of medullary thyroid carcinoma (MTC) such as calcitonin (Ctn) and other circulating markers, ultrasound (US), fine-needle aspiration (FNA), and other imaging procedures. Methods This systematic review of systematic reviews was carried out according to a predefined protocol. A search string was created. An electronical comprehensive search of literature was performed on December 2022. Quality assessment of eligible systematic reviews was performed and main findings were described. Results Twenty-three systematic reviews were included and several findings were achieved. Ctn is the most reliable diagnostic marker of MTC with no evidence of improvement with stimulation test. CEA doubling time is more reliable than Ctn in identifying MTC with poorer prognosis. US sensitivity is suboptimal in MTC and only just over half of cases are at high risk according to Thyroid Imaging And Reporting Data Systems. Cytology can correctly detect MTC in just over half of cases and measuring Ctn in washout fluid from FNA is necessary. PET/CT is useful for detecting recurrent MTC. Conclusions Future guidelines of both thyroid nodule management and MTC diagnosis should consider these evidence-based data.

Diagnosing medullary thyroid carcinoma is facilitated by measuring calcitonin in FNA washout fluids: Alea iacta est

“…2 FNA cytology is an essential examination when thyroid cancer is suspected after US; however, just over half of MTC cases are identified in cytological samples. 2 Serum calcitonin is the most sensitive and accurate tool for detecting MTC, however, routine measurement is not universally accepted for all patients diagnosed with thyroid nodules. 3,4 Strong evidence supports measuring calcitonin in FNA washout fluids, with an estimated sensitivity at 98%, showing consistency across studies.…”

“…3,4 Strong evidence supports measuring calcitonin in FNA washout fluids, with an estimated sensitivity at 98%, showing consistency across studies. 2 Ogmen et al 1 found that routine measurement of calcitonin in serum, coupled with the search for calcitonin in FNA fluids in patients with elevated serum values, led to an earlier MTC diagnosis. Sensitivities of both serum and FNA calcitonin were significantly higher than those of cytology alone.…”

“…The diagnosis of MTC remains challenging. Ultrasound (US) is acknowledged as the most reliable procedure for assessing malignancy risk in thyroid nodules, however, its accuracy in detecting MTC is low 2 . FNA cytology is an essential examination when thyroid cancer is suspected after US; however, just over half of MTC cases are identified in cytological samples 2 .…”

“…Ultrasound (US) is acknowledged as the most reliable procedure for assessing malignancy risk in thyroid nodules, however, its accuracy in detecting MTC is low 2 . FNA cytology is an essential examination when thyroid cancer is suspected after US; however, just over half of MTC cases are identified in cytological samples 2 . Serum calcitonin is the most sensitive and accurate tool for detecting MTC, however, routine measurement is not universally accepted for all patients diagnosed with thyroid nodules 3,4 .…”

“…Serum calcitonin is the most sensitive and accurate tool for detecting MTC, however, routine measurement is not universally accepted for all patients diagnosed with thyroid nodules 3,4 . Strong evidence supports measuring calcitonin in FNA washout fluids, with an estimated sensitivity at 98%, showing consistency across studies 2 . Ogmen et al 1 .…”