title: Measuring calcitonin in washout of the needle in patients undergoing fine needle aspiration with suspicious medullary thyroid cancer.
abstract: Calcitonin measurement in washout of the needle after aspiration (WO-Ct) has been rarely evaluated. Here we analyzed the role of WO-Ct in a series of subjects who underwent fine needle aspiration (FNA) with suspicious medullary thyroid cancer (MTC). Twenty-one patients referred following elevated serum calcitonin (S-Ct) or suspicious MTC by cytology. All patients underwent re-evaluation of S-Ct, FNA, and measurement of WO-Ct. S-Ct and WO-Ct were assessed by chemiluminescence assay (IMMULITE 2000, Diagnostic Products Corporation, USA). S-Ct showed elevated value in six subjects (mean 368.8 ± 373.9 pg/ml), of which three cases were cytologically classified as Class 5. WO-Ct obtained in this group (304.0 ± 309.3 pg/ml) was no different from S-Ct. After surgery MTC was confirmed in all patients. In the other 15 patients MTC was excluded by cytology or histology. Two subjects had moderately skewed S-Ct with nonmedullary histology. In the remaining 13 patients S-Ct resulted normal (6.2 ± 5.6 pg/ml) and WO-Ct low (2.9 ± 2.2 pg/ml). Significant (two-tailed P < 0.05, r(2) = 0.27, 95% confidence interval = 0.017-0.81) correlation was found between S-Ct and WO-Ct in nonmedullary patients but not in MTC patients. This study showed that WO-Ct can play a role in diagnosing primary and metastatic MTC. The procedure is easy, cost effective, and should be used in patients undergoing FNA with elevated S-Ct. Further studies and guidelines for the method are needed to use this technique in clinical routine. Until this any institute should use itself cut-off.
authors.affiliation: Section of Endocrinology and Diabetology, Ospedale Israelitico, Rome, Italy. pierpaolo.trimboli@gmail.com
authors.forename: P
authors.initials: P
authors.lastname: Trimboli
authors.forename: F
authors.initials: F
authors.lastname: Rossi
authors.forename: R
authors.initials: R
authors.lastname: Baldelli
authors.forename: O
authors.initials: O
authors.lastname: Laurenti
authors.forename: G
authors.initials: G
authors.lastname: Nigri
authors.forename: C
authors.initials: C
authors.lastname: Ventura
authors.forename: M
authors.initials: M
authors.lastname: Appetecchia
authors.forename: D
authors.initials: D
authors.lastname: Attanasio
authors.forename: F
authors.initials: F
authors.lastname: Romanelli
authors.forename: L
authors.initials: L
authors.lastname: Guidobaldi
authors.forename: M
authors.initials: M
authors.lastname: Guarino
authors.forename: A
authors.initials: A
authors.lastname: Crescenzi
authors.forename: S
authors.initials: S
authors.lastname: Valabrega
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D044963:Biopsy, Fine-Needle; D002116:Calcitonin / Q000097:blood*; D018278:Carcinoma, Neuroendocrine; D002467:Cell Nucleus / Q000473:pathology; D005260:Female; D006801:Humans; D008163:Luminescent Measurements / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011933:Reagent Kits, Diagnostic; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology
chemical_list: D014408:Biomarkers, Tumor; D011933:Reagent Kits, Diagnostic; D002116:Calcitonin