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

Shakir, Mohamed K M; Hoang, Thanh D.; Elegino-Steffens, Diane U.; Vinh, Q.; Clyde, Patrick W.

doi:10.14740/jem371w

Cited by 1 publication

(3 citation statements)

References 39 publications

(132 reference statements)

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“…When used in conjunction with serum Ctn, high serum Pctn to Ctn ratio has been shown to have increased risk of disease and shortened progression-free survival [4]. There has been one case series of 3 patients with MTC demonstrating increased FNA Pctn levels compared to serum level, but further studies are needed before routine use is recommended [38].…”

Section: Procalcitoninmentioning

confidence: 99%

“…As a screening test for the initial evaluation of MTC, CEA is not practical due to its low specificity. Potentially improving on specificity, one case series of 3 patients with MTC demonstrated increased CEA levels in FNA washout fluid compared to serum levels [38]. Case reports have also detailed CEA as the initial lab abnormality in detection of MTC.…”

Section: Carcinoembryonic Antigenmentioning

confidence: 99%

“…When MTC is considered as a possible diagnosis, performing a Ctn washout of the FNA sample has increased detection sensitivity approaching 95% or higher in several studies [38,[47][48][49]. The ATA guidelines for MTC also recommend immunocytochemical staining for Ctn, CEA, and chromogranin when cytology is inconclusive [4].…”

Section: Fine Needle Aspirationmentioning

confidence: 99%

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Diagnostic Challenges of Medullary Thyroid Carcinoma

2021

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Background: Medullary thyroid carcinoma (MTC) comprises 1–2% of all thyroid cancers, yet 15% of all thyroid cancer-related deaths. While up to 20% of cases may be predicted due to autosomal dominant germline mutations, 80% of cases are sporadic. However, due to non-specific presenting symptoms and diagnostic imaging, prompt diagnosis and treatment has remained elusive. This article will further investigate the limitations of MTC diagnosis and look into future areas for diagnostic improvement. Methods: Relevant articles were identified using a systematic PubMed and Google Scholar search. Results: Prophylactic total thyroidectomy for the 20% of MTC cases that are present in autosomal dominant disorder provides definitive treatment. Serum calcitonin (Ctn) screening has several technical limitations due to population variability and laboratory assay interference, but advances in laboratory technology and combined use with fine needle aspiration increase its sensitivity. Other serum assays such as carcinoembryonic antigen and procalcitonin have limited applicability. Thyroid ultrasound remains the gold standard for the initial diagnostic planning, with limited application for CT, MRI, and PET imaging. Conclusion: With complete surgical resection the only definitive treatment, early MTC diagnosis has presented an elusive challenge, mainly due to its relative rarity and difficulty in finding an economic screening strategy. Careful family history combined with fine needle aspiration with serum Ctn analysis can improve diagnostic sensitivity and specificity to greater than 95%.

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Section: Procalcitoninmentioning

confidence: 99%

Section: Carcinoembryonic Antigenmentioning

confidence: 99%