Ultrasonographic findings of medullary thyroid cancer: differences according to tumor size and correlation with fine needle aspiration results

Choi, Nami; Moon, Won-Jin; Lee, Jeong Hyun; Baek, Jung Hwan; Kim, Dong Wook; Park, Sun Won

doi:10.1258/ar.2010.100247

Cited by 59 publications

(62 citation statements)

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“…Saller and colleagues [5] compared 19 MTC patients referred over six years with 71 subjects with benign nodules. Seventeen (89%) MTC nodules had hypoechoic appearance, calcifications and no halo sign, with at least one US risk factor was in agreement with both these papers [8,9].…”

Section: Discussionsupporting

confidence: 80%

“…In agreement with that previously reported, cytologic examination classified as Class 5 only 7/12 subjects of the series. Based on previously reported data [4][5][6][7][8][9] and the present results, MTC diagnosis seems to be difficult also by US examination. In this context, it has to be mentioned that ATA panel [21] does not recommend either for or against routine measurement of Ct, while AACE/AME/ETA guidelines [3] suggests Ct in the routine workup of thyroid nodules.…”

Section: Discussionsupporting

confidence: 71%

“…However, these large studies focused on differentiated papillary carcinoma (PTC), mainly due to its higher prevalence (about 80%) out of thyroid cancers. On the contrary, because of the low prevalence of MTC, a few papers analyzed US characteristics associated with this cancer type [4][5][6][7][8][9]. The lack of this information, together with the poor accuracy of cytology and not routine testing of calcitonin (Ct), should contribute to the low rate of MTC and, probably, to its delayed diagnosis [10,11].…”

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confidence: 99%

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Should we use ultrasound features associated with papillary thyroid cancer in diagnosing medullary thyroid cancer?

et al. 2012

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In thyroid nodule management, ultrasound (US) features, such as hypoechogenicity of the lesion, irregular\ud margins, microcalcifications, and intralesional vascular signal, alone or combined, have to be considered as suggestive for\ud malignancy. Because of the low prevalence of medullary thyroid cancer (MTC), a few papers analyzed US characteristics\ud associated with this cancer in small series, with controversial results. Aim of this study was to evaluate in MTC the US risk\ud factors of thyroid nodule. In this order, a series of nodules histologically proven as MTC and a group of nodules with\ud histology of papillary cancer (PTC) were retrospectively compared with a control group of benign nodule. Fifty percent\ud MTC were solid hypoechoic and 16% showed microcalcifications with significant difference with respect to the benign\ud group (p<0.05 for both parameters), while no significant difference was recorded regarding margins nor nodular\ud vascularization. The presence of at least one US risk feature was almost equal in MTC (58.3%) and controls (55.5%). On\ud the contrary, at least one US risk factor was significantly (p<0.001) more frequent in PTC than in benign group or MTC\ud series. This study showed low frequency of ultrasound features associated to PTC when analyzed in medullary cancer.\ud Because of the poor literature focusing on this topic, and the herein used design, these data contribute to the knowledge\ud about presentation of MTC at US. We advice for further prospective studies on larger series to define the US presentation\ud of this cancer type

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 71%

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confidence: 99%

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Should we use ultrasound features associated with papillary thyroid cancer in diagnosing medullary thyroid cancer?

et al. 2012

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“…Microcalcifications occurred in 35.5%, and macrocalcifications in a further 27.0%. Irregular margins were moderately common (38.0%) in MTCs; however, there was significant heterogeneity due to the great dispersion of results of particular studies -from 0% [5] to nearly 50% [11]. Partly this could be the effect of the small number of studies assessing this feature.…”

Section: Discussionmentioning

confidence: 99%

Cechy sonograficzne raków rdzeniastych tarczycy — przegląd systematyczny i metaanaliza

Woliński

Rewaj-Łosyk

Ruchała

2014

Endokrynologia Polska

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Introduction: Thyroid nodular goitre is one of the most common endocrine disorders. Differentiating between benign and malignant lesions is an emerging challenge in endocrinological practice. Ultrasonography (US) remains the most commonly applied method in the preliminary assessment of lesions and is the basis for the decision as to fine needle aspiration biopsy (FNAB) and further diagnostics. Many studies have evaluated the diagnostic value of US malignancy features. However, they focused mainly on papillary thyroid cancer (PTC). It remains unclear whether other types of thyroid carcinoma (TC) are also characterised by the same US features. The aim of this study was to assess the usefulness of US features considered as markers in the diagnosis of medullary thyroid cancer (MTC). Material and methods:The PubMed/MEDLINE and Cochrane Library databases were searched to identify studies on US features of MTCs. The random-effects model was used to calculate pooled sensitivity and specificity and odds ratios (OR) -if a comparison with PTCs was available. Results: Hypoechogenicity was present in 83.4% of MTCs, and 32.7% were markedly hypoechogenic. None of the 157 MTCs was hyperechogenic. Sensitivity of halo absence was 88.9%, but irregular margins were present in 38.0%. 35.5% of MTCs had microcalcifications, and 27.0% had macrocalcifications. 14.4% presented 'taller than wide feature' (higher anteroposterior than transverse diameter). Apart from macrocalcifications, all these features occurred insignificantly less often in MTCs than in PTCs. Conclusions: US features commonly considered as markers of malignancy can be useful also in the diagnostics of MTCs. However, MTCs tend to possess suspicious US features slightly less often than PTCs. Some features, such as hyperechogenicity, can be considered to be strong markers of benign status. Although the US appearance of the thyroid lesion is an important diagnostic factor, it is worth remembering that it does not allow for a definitive differentiation between benign and malignant nodules. In the case of MTCs, as well as other TCs, US examination remains a valuable diagnostic tool, but should always be interpreted carefully in the context of other examinations.

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“…More significant is that non-specific cytological features may wrongly suggest tumors other than MTC. These false negative diagnoses result in the failure to cytologically diagnose MTC, and lower cytological sensitivity for MTC (45,(47)(48)(49)(50)(51)(52)(53)(54)). An abstract reporting 14 samples (from 13 patients) that positively expressed the MTC gene expression signature in the Afirma GEC rare neoplasm cassettes found that all 14 were confirmed as MTC on histopathology (55).…”

Section: Rare Neoplasmsmentioning

confidence: 99%

Molecular markers in the diagnosis of thyroid nodules

Ward

Kloos²

2013

Arq Bras Endocrinol Metab

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SUMMARYAn indeterminate thyroid nodule cytology result occurs about every sixth fine-needle aspiration. These indeterminate nodules harbor a 24% risk of malignancy (ROM); too high to ignore, but driving surgery where most nodules are benign. Molecular diagnostics have emerged to ideally avoid surgery when appropriate, and to trigger the correct therapeutic surgery when indicated, as opposed to an incomplete diagnostic surgery. No current molecular test offers both high sensitivity and high specificity. A molecular diagnostic test with high sensitivity (e.g. Afirma Gene Expression Classifier sensitivity 90%) offers a high Negative Predictive Value when the ROM is relatively low, such as < 30%. Only such tests can "rule-out" cancer. In this setting, a molecularly benign result suggests the same ROM as that of operated cytologically benign nodules (~6%). Thus, clinical observation can replace diagnostic surgery; increasing quality of life and decreasing medical costs. However, its low specificity cannot "rule-in" cancer as a suspicious result has a Positive Predictive Value (PPV) of ~40%, perhaps too low to routinely reflex to definitive cancer surgery. Conversely, high specificity tests (BRAF, RAS, PPAR/PAX-8, RET/PTC, PTEN) offer high PPV results, and only these tests can "rule-in" cancer. Here a positive molecular result warrants definitive therapeutic surgery. However, their low sensitivity cannot "rule-out" cancer and a negative molecular result cannot dissuade diagnostic surgery; limiting their cost-effectiveness. Whether or not there is a useful and cost-effective role to sequentially combine these approaches, or to modify existing approaches, is under investigation. Arq Bras Endocrinol Metab. 2013;57(2):89-97 Keywords Biopsy, fine-needle; DNA mutational analysis; gene expression; genomics; molecular diagnostic techniques SUMáRioResultados indeterminados na citologia de um nódulo tireoidiano ocorrem em cerca de um a cada seis punções aspirativas por agulha fina. Esses nódulos indeterminados apresentam risco de malignidade (RM) de cerca de 24%, um valor alto demais para ser ignorado e que leva à cirurgia em casos em que a maioria dos nódulos é benigna. O diagnóstico molecular é uma forma ideal de se evitar a cirurgia quando apropriado e de se levar ao correto procedimento cirúrgico terapêutico quando indicado, em oposição à cirurgia diagnóstica incompleta. Atualmente, não existem testes moleculares com alta sensibilidade e especificidade. Um teste molecular de alta sensibilidade (por exemplo, a sensibilidade do teste Afirma Gene Expression Classifier é de 90%) tem um alto Valor Preditivo Negativo quando o RM é relativamente baixo, por exemplo, < 30%. Apenas esses testes podem "excluir" o câncer. Nesse contexto, um resultado molecular benigno sugere o mesmo RM de nódulos com resultado benigno na citologia e operados (~6%). Assim, a observação clínica pode substituir a cirurgia diagnóstica, aumentando a qualidade de vida e diminuindo os custos médicos. Entretanto, a baixa especificidade não pode "incluir" o cân...

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Ultrasonographic findings of medullary thyroid cancer: differences according to tumor size and correlation with fine needle aspiration results

Abstract: Based on US, the majority of MTCs can be classified as suspiciously malignant due to the presence of micro- or macro-calcifications. Small MTC size (≤ 10 mm) and a smooth margin may be factors predicting false-negative FNA results.

Cited by 59 publications

References 15 publications

Should we use ultrasound features associated with papillary thyroid cancer in diagnosing medullary thyroid cancer?

Should we use ultrasound features associated with papillary thyroid cancer in diagnosing medullary thyroid cancer?

Cechy sonograficzne raków rdzeniastych tarczycy — przegląd systematyczny i metaanaliza

Molecular markers in the diagnosis of thyroid nodules

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