The application value of modified thyroid imaging report and data system in diagnosing medullary thyroid carcinoma

Zhu, Jia‐Lin; Li, Xing; Wei, Xi; Yang, Xueling; Zhao, Jing; Zhang, Sheng; Guo, Zhi

doi:10.1002/cam4.2217

Cited by 17 publications

(35 citation statements)

References 27 publications

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“…Approximately 95 % of MTC correspond to nodules with an intermediate or high suspicion sonographic pattern according to the ATA classification or to nodules categories 4 and 5 of TI-RADS [12][13][14][15]. FNA is recommended for non-autonomous nodules > 1 cm with this ultrasonographic appearance.…”

Section: Discussionmentioning

confidence: 99%

“…Since MTC is uncommon, the challenge is to select individuals who would be the best candidates for this screening, increasing the cost-effectiveness of this management. First, as adopted in this study, Ctn measurement can be limited to nodules with an intermediate or high suspicion sonographic pattern (or TI-RADS 4 or 5) since few cases of MTC (about 5 %) exhibit a low or very low suspicion sonographic pattern [12][13][14][15]. Second, age can be an additional criterion, with the suggestion to restrict screening for sporadic MTC by Ctn measurement for individuals ≥ 40 years [22].…”

Section: Discussionmentioning

confidence: 99%

“…Finally, only patients who had nodules with two or more suspicious features (solid or predominantly solid, hypoechogenicity, microcalcifications, irregular margins, anteroposterior diameter larger than transverse diameter) were included. Using this criterion, the nodules would currently be classified as intermediate or high suspicion by ATA or TI-RADS 4 or 5 [12][13][14][15].…”

Section: Patientsmentioning

confidence: 99%

“…Considering that approximately 95 % of MTC correspond to nodules defined as intermediate or high suspicion by the sonographic classification of the American Thyroid Association (ATA) or as category 4 or 5 of the Thyroid Imaging, Reporting and Data System (TI-RADS) [12][13][14][15], the lack of diagnosis of microMTC would be a matter of concern primarily in the case of thus classified nodules measuring ≤ 1 cm.…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of Serum Calcitonin in Patients with Thyroid Nodules ≤ 1 cm Without an Indication for Fine-Needle Aspiration

2020

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Fine-needle aspiration (FNA) is not necessary in adults with nodules ≤ 1 cm without apparent extrathyroidal extension (ETE) or lymph node (LN) involvement on ultrasonography (US). In the absence of FNA and serum calcitonin (Ctn) measurement, medullary thyroid microcarcinomas (microMTC) are not diagnosed. The aim of this prospective study was to evaluate Ctn levels in adults with a low clinical risk of MTC and nodules ≤ 1 cm without ETE or LN involvement on US. A total of 506 consecutively seen adults who had nodules with two or more suspicious features were included. Patients with elevated basal Ctn underwent a calcium stimulation test and FNA. Basal Ctn was normal in 490 patients (96.8%). In the 16 patients with elevated basal Ctn, FNA revealed MTC in only one patient and MTC was not suspected in the 15 patients with elevated basal Ctn. Three patients with stimulated Ctn<100 pg/ml and benign cytology were not submitted to surgery. MTC was excluded by histology in three patients with stimulated Ctn<100 pg/ml and indeterminate or suspicious cytology and in eight patients with stimulated Ctn>100 pg/ml. One patient with stimulated Ctn>100 pg/ml had MTC. Ctn was undetectable 6 months after surgery in two patients with MTC. Although uncommon, even subjects without a suspicious history and with nodules ≤ 1 cm without ETE or LN involvement on US, but with suspicious findings, can have microMTC. The measurement of Ctn permits the diagnosis of these cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Usefulness of Serum Calcitonin in Patients with Thyroid Nodules ≤ 1 cm Without an Indication for Fine-Needle Aspiration

2020

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“…Most classification systems, including TI-RADS, are primarily applicable to papillary thyroid carcinoma. There was only a few studies researched the application of TI-RADS in assessing MTC [ 8 , 9 ], and the applicability of TI-RADS in MTC patients is still not sufficient.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound features of medullary thyroid cancer as predictors of biological behavior

et al. 2021

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Background Medullary thyroid cancer (MTC) has more aggressive behavior and poor prognosis. Ultrasound (US) has facilitated the qualitative diagnosis of thyroid nodules, however, some MTC may be diagnosed as a benign nodule on ultrasound because ultrasound features of malignancy are lacking. The aim of the study was to investigate the association between ultrasound features and biological behavior of MTC. Methods Ultrasound findings and medical records of patients with MTC between Jan 2015 to Jun 2017 were retrospectively reviewed at Tianjin Medical University Cancer Institute and Hospital. MTC were categorized using modified TI-RADS classification, then were classified as “malignant” (m-MTC) or “US-low-suspicious” (l-MTC). We compared the biological behavior between the two groups, and further analyzed the risk factors for the recurrence. Results A total of 78 patients were enrolled, of which 55 m-MTC (70.5%) and 23 l-MTC (29.5%) were identified. The N staging of the m-MTC was significantly higher than that of l-MTC(P = 0.000). The preoperative serum Ct level in m-MTC were significantly higher than that of l-MTC(P = 0.035). Biochemical cure were more frequent in l-MTC than that of m-MTC (P = 0.002). Disease recurrence rates were 19.7% (14 of 71). Disease recurrence was more frequent in m-MTC than that of l-MTC (P = 0.013). Disease recurrence was positively associated with extrathyroid extension (P = 0.047), N staging (P = 0.003), preoperative serum Ct level (P = 0.009) and negatively associated with biochemical cure(P = 0.000). In multivariable Cox regression analysis, extrathyroid extension and biochemical cure were independent risk factors for recurrence of MTC. Conclusions L-MTC has a more indolent character than m-MTC. The extrathyroid extension and biochemical cure were independent risk factors for recurrence of MTC.

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An old friend, a new insight: Calcitonin measurement in serum and aspiration needle washout fluids significantly increases the early and accurate detection of medullary thyroid cancer

Ogmen,

Ince,

Aksoy Altınboga

et al. 2023

Cancer Cytopathology

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BackgroundThe sensitivity of cytological (CY) evaluation after fine‐needle aspiration (FNA) for detecting medullary thyroid carcinoma (MTC) is a subject of controversy. The routine use of serum calcitonin (CT) in patients with thyroid nodules is not universally adopted. The authors conducted CT screening of FNA washout fluid (FNA‐CT) to address the diagnostic challenges. The objective was to assess the contributions of serum CT, FNA cytology (FNA‐CY), and FNA‐CT to the diagnosis.MethodsBetween February 2019 and June 2022 (group 1), the authors prospectively screened the CT of patients with thyroid nodules. Both FNA‐CY and FNA‐CT were performed for patients with persistently elevated CT values. The sensitivity of FNA‐CY, serum CT, and FNA‐CT for accurate diagnosis was evaluated. Additionally, the authors retrospectively examined data from patients with thyroid nodules before CT screening (2008–2019) (group 2). They compared the characteristics of MTC patients in groups 1 and 2.ResultsMTC was identified in 30 patients (0.25%) in group 1 and 19 (0.07%) in group 2. A FNA‐CT cutoff value of 4085.5 pg/mL detected MTC with a sensitivity of 96.8%, and a serum CT cutoff value of 28.3 pg/mL detected MTC with a sensitivity of 86.7%. In contrast, FNA‐CY detected MTC with a sensitivity of 42.4%. In group 1, 18 patients (60%) with MTC were diagnosed with microcarcinoma, whereas only two patients (10.5%) in group 2 had microcarcinoma.ConclusionsThis study detected MTC earlier by routinely measuring serum CT in all patients with nodular thyroid disease and performing FNA‐CT in those with elevated values. FNA‐CT and serum CT sensitivities were significantly higher than those of FNA‐CY. This study revealed different FNA‐CT cutoff values compared to other studies, emphasizing the need for determining clinic‐specific cutoff values.

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The application value of modified thyroid imaging report and data system in diagnosing medullary thyroid carcinoma

Cited by 17 publications

References 27 publications

Usefulness of Serum Calcitonin in Patients with Thyroid Nodules ≤ 1 cm Without an Indication for Fine-Needle Aspiration

Usefulness of Serum Calcitonin in Patients with Thyroid Nodules ≤ 1 cm Without an Indication for Fine-Needle Aspiration

Ultrasound features of medullary thyroid cancer as predictors of biological behavior

An old friend, a new insight: Calcitonin measurement in serum and aspiration needle washout fluids significantly increases the early and accurate detection of medullary thyroid cancer

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