title: Fine needle aspiration and medullary thyroid carcinoma: the risk of inadequate preoperative evaluation and initial surgery when relying upon FNAB cytology alone.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy of fine-needle aspiration biopsy (FNAB) to preoperatively diagnose medullary thyroid cancer (MTC) among multiple international centers and evaluate how the cytological diagnosis alone could impact patient management.
  
  
  METHODS
  We performed a retrospective chart review of sporadic MTC (sMTC) patients from 12 institutions over the last 29 years. FNAB cytology results were compared to final pathologic diagnoses to calculate FNAB sensitivity. To evaluate the impact of cytology sensitivity for MTC according to current practice and to avoid confounding results by local treatment protocols, changes in treatment patterns over time, and the influence of ancillary findings (e.g., serum calcitonin), therapeutic interventions based on FNAB cytology alone were projected into 1 of 4 treatment categories: total thyroidectomy (TT) and central neck dissection (CND), TT without CND, diagnostic hemithyroidectomy, or observation.
  
  
  RESULTS
  A total of 313 patients from 4 continents and 7 countries were included, 245 of whom underwent FNAB. FNAB cytology revealed MTC in 43.7% and possible MTC in an additional 2.4%. A total of 113 (46.1%) patients with surgical pathology revealing sMTC had FNAB findings that supported TT with CND, while 37 (15.1%) supported TT alone. In the remaining cases, diagnostic hemithyroidectomy and observation were projected in 32.7% and 6.1%, respectively.
  
  
  CONCLUSIONS
  FNAB is an important diagnostic tool in the evaluation of thyroid nodules, but the low sensitivity of cytological evaluation alone in sMTC limits its ability to command an optimal preoperative evaluation and initial surgery in over half of affected patients.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio.
authors.forename: Garth F
authors.initials: GF
authors.lastname: Essig
authors.forename: Kyle
authors.initials: K
authors.lastname: Porter
authors.forename: David
authors.initials: D
authors.lastname: Schneider
authors.forename: Arpaia
authors.initials: A
authors.lastname: Debora
authors.forename: Susan C
authors.initials: SC
authors.lastname: Lindsey
authors.forename: Giulia
authors.initials: G
authors.lastname: Busonero
authors.forename: Daniel
authors.initials: D
authors.lastname: Fineberg
authors.forename: Barbara
authors.initials: B
authors.lastname: Fruci
authors.forename: Kristien
authors.initials: K
authors.lastname: Boelaert
authors.forename: Johannes W
authors.initials: JW
authors.lastname: Smit
authors.forename: Johannes Arnoldus Anthonius
authors.initials: JA
authors.lastname: Meijer
authors.forename: Leonidas
authors.initials: L
authors.lastname: Duntas
authors.forename: Neil
authors.initials: N
authors.lastname: Sharma
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Costante
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Filetti
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Sippel
authors.forename: Bernadette
authors.initials: B
authors.lastname: Biondi
authors.forename: Duncan J
authors.initials: DJ
authors.lastname: Topliss
authors.forename: Furio
authors.initials: F
authors.lastname: Pacini
authors.forename: Rui M B
authors.initials: RM
authors.lastname: Maciel
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Walz
authors.forename: Richard T
authors.initials: RT
authors.lastname: Kloos
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D044963:Biopsy, Fine-Needle / Q000379:methods*; D018276:Carcinoma, Medullary / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018813:Multiple Endocrine Neoplasia Type 2a / Q000175:diagnosis / Q000473:pathology; D009367:Neoplasm Staging; D011300:Preoperative Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D016606:Thyroid Nodule / Q000175:diagnosis / Q000473:pathology; D013965:Thyroidectomy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers