Incidentally Discovered Medullary Thyroid Cancer: Diagnostic Strategies and Treatment

Abstract

Occult MTC is an uncommon, but clinically significant entity. If calcium stimulation testing cutoff data become well-validated, calcitonin screening would likely become more widely accepted in the diagnostic work-up for thyroid nodules in the United States. Among patients with incidental MTC, those with persistently elevated serum calcitonin levels, positive RET test, or nodal disease are good candidates for completion thyroidectomy and lymph node dissection in selected cases, whereas patients with undetectable calcitonin, negative RET testing, and no sonographic abnormalities often may be watched conservatively.

Preoperatively undiagnosed papillary thyroid carcinoma in patients thyroidectomized for benign multinodular goiter

“…Considering thyroid gland, the identification of thyroid cancer may be classified into 3 broad categories: 1) clinically detected cancer (not incidentally detected), 2) radiologically detected cancer (clinically unsuspected), and 3) pathologically detected cancer (clinically and radiologically unsuspected) (1). Incidental thyroid cancers (ITCs) are often microcarcinomas, most frequently of the papillary histotype (2)(3)(4)(5)(6); the mean tumor size of ITCs decreased during the last decades (3,6). Namely, Boucek and cols.…”

The Role of Core Needle Biopsy and Its Impact on Surgical Management in Patients with Medullary Thyroid Cancer: Clinical Experience at 3 Medical Institutions

“…Although it accounts for only 3%-5% of thyroid cancer diagnoses, it causes 15% of thyroid cancer-related deaths due to its aggressiveness. 1 Due to a lack of good treatment options other than surgery, early diagnosis of MTC and complete surgical resection comprising at least total thyroidectomy with central lymph node dissection offers the best chance for a cure. [2][3][4][5] In that respect, accurate and timely diagnosis of MTC is essential to ensure the appropriate surgical procedure.…”

Modified Fine-Needle Aspiration Biopsy for Calcitonin, Procalcitonin and Carcinoembryonic Antigen Levels in the Diagnosis of Thyroid Nodules With Medullary Thyroid Carcinoma

“…thyroid nodules, basal serum concentrations of Ct, along with pentagastrin-stimulated or calcium-stimulated serum Ct, have been used to diagnose MTC [1][2][3][4][5][6][7][8][9][10][11][12]. RET proto-oncogene testing for identifying familial forms may also aid in case identification [20,21].…”

“…Minimally, or even moderately, elevated serum concentrations of Ct may not distinguish MTC from other benign conditions [1][2][3][4][5][6][7][8][9]. Fineneedle biopsy (FNB) of thyroid nodules is commonly used for malignancy evaluation [9][10][11][12][13][14][15][16][17][18]. The majority of previously published reports indicate that FNB has relatively low sensitivity [5,7,9,[13][14][15][16][17].…”

“…However, some studies have demonstrated a good sensitivity for diagnosing MTC [11,18] in a patient with moderately elevated serum Ct levels and thyroid nodule. However, mild elevations in serum Ct may be related to a benign disorder [1][2][3][4][5][6][7][8][9][10], and several additional options are available to confirm the diagnosis of MTC in these cases, such as FNB of the thyroid nodule, a calcium-pentagastrin stimulation test, a calcium stimulation test and an RET proto-oncogene test . Although elevated basal serum Ct level has been used in the preoperative diagnosis of MTC, it is well established that mildly or moderately elevated serum Ct levels may be seen in disorders other than MTC [1][2][3][4][5][6][7][8][9][10].…”