title: Calcitonin measurement in aspiration needle washout fluids has higher sensitivity than cytology in detecting medullary thyroid cancer: a retrospective multicentre study.
abstract: OBJECTIVE
  Only few studies analysed the capability of cytology in detecting medullary thyroid cancer (MTC), and they reported a low accuracy of this diagnostic technique. Recently, calcitonin (CT) measurement in aspiration needle washout (FNA-CT) of thyroid and neck lesions has been reported as a sensitive tool for MTC. The aim of this study is to compare the sensitivity of FNA-CT and cytology in detecting MTC and to assess a cut-off value of FNA-CT for clinical practice.
  
  
  METHODS
  Thirty-eight MTC lesions from 36 patients were retrospectively studied, diagnosed and treated in four different centres. Furthermore, 52 nonmedullary lesions from subjects undergone biopsy following increased serum CT were collected as a control group.
  
  
  RESULTS
  Cytology detected MTC in 21/37 lesions with 56·8% sensitivity. The median FNA-CT value was 2000 pg/ml (range 58-10 000 pg/ml) in MTC and 2·7 pg/ml (range <2-13 pg/ml) in controls (P < 0·001). Using a cut-off of 39·6 pg/ml, MTC lesions could be identified with 100% sensitivity and specificity. As the most important finding, 14 histologically proved MTC lesions could be detected by FNA-CT, despite they were cytologically diagnosed as benign or nonconclusive.
  
  
  CONCLUSIONS
  This study shows, as the first in a multicentre series, that FNA-CT sensitivity is higher than that of cytology in diagnosing MTC. To avoid false-negative MTC by cytology, CT measurement in aspiration needle washout is to be performed in all patients undergoing biopsy following high serum CT.
authors.affiliation: Section of Endocrinology and Diabetology, Ospedale Israelitico, Rome, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Trimboli
authors.forename: Nadia
authors.initials: N
authors.lastname: Cremonini
authors.forename: Luca
authors.initials: L
authors.lastname: Ceriani
authors.forename: Enrico
authors.initials: E
authors.lastname: Saggiorato
authors.forename: Leo
authors.initials: L
authors.lastname: Guidobaldi
authors.forename: Francesco
authors.initials: F
authors.lastname: Romanelli
authors.forename: Claudio
authors.initials: C
authors.lastname: Ventura
authors.forename: Oriana
authors.initials: O
authors.lastname: Laurenti
authors.forename: Ilaria
authors.initials: I
authors.lastname: Messuti
authors.forename: Erica
authors.initials: E
authors.lastname: Solaroli
authors.forename: Raffaele
authors.initials: R
authors.lastname: Madaio
authors.forename: Massimo
authors.initials: M
authors.lastname: Bongiovanni
authors.forename: Fabio
authors.initials: F
authors.lastname: Orlandi
authors.forename: Anna
authors.initials: A
authors.lastname: Crescenzi
authors.forename: Stefano
authors.initials: S
authors.lastname: Valabrega
authors.forename: Luca
authors.initials: L
authors.lastname: Giovanella
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods*; D002116:Calcitonin / Q000032:analysis*; D018278:Carcinoma, Neuroendocrine; D003584:Cytological Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013961:Thyroid Gland / Q000378:metabolism / Q000473:pathology; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000378:metabolism*; D016606:Thyroid Nodule / Q000175:diagnosis / Q000378:metabolism
chemical_list: D002116:Calcitonin