title: The diagnostic value of calcitonin measurement in wash-out fluid from fine-needle aspiration of thyroid nodules in the diagnosis of medullary thyroid cancer.
abstract: OBJECTIVE
  The diagnostic value of calcitonin measurement in fine-needle aspiration biopsy (FNAB) wash-out fluid (Ct-FNAB) for medullary thyroid cancer (MTC) remains to be determined. This prospective study aimed to assess the diagnostic value of Ct-FNAB in thyroid nodules in comparison with basal serum calcitonin (Ct), pentagastrin-stimulated Ct (Pg-sCt), and cytology.
  
  
  METHODS
  Among patients with goiter addressed with US-FNAB who had an initial clinical suggestion for thyroidectomy, 27 patients with thyroid nodule/s (n = 60) and normal, borderline, or increased Ct fulfilled the criteria for thyroidectomy. All 27 patients (enrolled according to exclusion/inclusion criteria) underwent ultrasonography (US), Ct, Pg-sCt, US-assisted FNAB of each patient's nodule for both cytology, and Ct-FNAB before thyroidectomy.
  
  
  RESULTS
  Ct-FNAB always resulted in >1,000 pg/mL in MTC nodules at histology. For values between 36 and 1,000 pg/mL, MTCs and nodular or micronodular C-cell hyperplasia (CCH) results overlapped. Most of the nodules without MTC and/or CCH had Ct-FNAB ≤ 17 pg/mL. Ct-FNAB diagnostic power was superior to and similar to other diagnostic procedures (Ct, Pg-sCt, and cytology) in identifying both MTC and CCH, and MTC alone, respectively.
  
  
  CONCLUSIONS
  The diagnostic power of Ct-FNAB is valuable compared with other routine procedures. Ct-FNAB is highly reliable for the early detection and accurate localization of MTC in thyroid nodules, but it does not differentiate between MTC and CCH. Ct-FNAB is an extremely valuable diagnostic tool, especially considering that other diagnostic procedures do not provide a definitive diagnosis, and it can be included in the clinical work-up of thyroid nodules when MTC is suspected.
authors.affiliation: Department of Biomedical, Metabolic and Neural Sciences, Unit and Chair of Endocrinology and Metabolism Integrated Department of Medicine, Endocrinology and Metabolism, Geriatrics, University of Modena and Reggio Emilia, Azienda AUSL of Modena, NOCSAE of Baggiovara, Modena, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Diazzi
authors.forename: Bruno
authors.initials: B
authors.lastname: Madeo
authors.forename: Erica
authors.initials: E
authors.lastname: Taliani
authors.forename: Lucia
authors.initials: L
authors.lastname: Zirilli
authors.forename: Stefania
authors.initials: S
authors.lastname: Romano
authors.forename: Antonio R M
authors.initials: AR
authors.lastname: Granata
authors.forename: Maria C
authors.initials: MC
authors.lastname: De Santis
authors.forename: Manuela
authors.initials: M
authors.lastname: Simoni
authors.forename: Katia
authors.initials: K
authors.lastname: Cioni
authors.forename: Cesare
authors.initials: C
authors.lastname: Carani
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Rochira
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D002116:Calcitonin / Q000032:analysis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000378:metabolism*; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000378:metabolism*
chemical_list: D002116:Calcitonin