title: Calcitonin measurement in fine-needle aspirate washouts vs. cytologic examination for diagnosis of primary or metastatic medullary thyroid carcinoma.
abstract: Ultrasound-guided fine-needle aspiration biopsy cytology (FNAB-C) is able to detect approximately 63% of medullary thyroid carcinoma (MTC). The measurement of calcitonin in the needle washout (FNAB-CT) could improve its accuracy. Sixty-two FNAB-C were performed in 38 patients. Serum calcitonin (sCT) was measured before performing FNAB-C. After obtaining a FNAB-C specimen, the needle was washed with 0.5 ml of saline solution to obtain the CT washouts. Receiver operating characteristic (RO C) analysis identified the cut-offs of FNAB-CT and FNAB-CT/sCT. Eighteen MTC were found at final histology. RO C analysis indicated FNAB-CT > 10.4 pg/ml and FNABCT/ sCT > 1.39 as more accurate cut-off values. Overall accuracy, positive (PPV) and negative predictive values (NPV) were 85%, 100 and 83%, respectively, for FNAB-C, 97%, 100%, 96% for FNAB-CT and 90%, 83% and 93% for FNAB-CT/sCT. The integration of FNAB-C and FNAB-CT resulted in 98% overall accuracy, 100% PPV and 98% NPV; the integration of FNAB-C and FNAB-CT/sCT in 90% overall accuracy, 80% PPV and 95% NPV. One of 2 false negative FNAB-CT and one of 3 false negative FNAB CT/sCT were correctly diagnosed by FNAB-C. Eight of 9 non-diagnostic FNAB-C were correctly classified by FNAB-CT and 7 by FNAB CT/sCT. FNAB-CT should integrate but not replace FNAB-C. FNAB-CT is particularly useful in the presence of non-diagnostic FNAB-C.
authors.affiliation: UO Chirurgia Endocrina e Metabolica.
authors.forename: C
authors.initials: C
authors.lastname: de Crea
authors.affiliation: UO Chirurgia Endocrina e Metabolica.
authors.forename: M
authors.initials: M
authors.lastname: Raffaelli
authors.affiliation: UO Chirurgia Endocrina e Metabolica.
authors.forename: D
authors.initials: D
authors.lastname: Maccora
authors.affiliation: UO Analisi Ormonali and.
authors.forename: C
authors.initials: C
authors.lastname: Carrozza
authors.affiliation: UO Analisi Ormonali and.
authors.forename: G
authors.initials: G
authors.lastname: Canu
authors.affiliation: UO Anatomia Patologica e Istologia, Policlinico "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Fadda
authors.affiliation: UO Chirurgia Endocrina e Metabolica.
authors.forename: R
authors.initials: R
authors.lastname: Bellantone
authors.affiliation: UO Chirurgia Endocrina e Metabolica.
authors.forename: C P
authors.initials: CP
authors.lastname: Lombardi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D002116:Calcitonin / Q000032:analysis*; D018278:Carcinoma, Neuroendocrine / Q000737:chemistry / Q000473:pathology* / Q000556:secondary*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013964:Thyroid Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000556:secondary*; D055815:Young Adult
chemical_list: D002116:Calcitonin
keywords: Calcitonin; Cytology; Lymph node metastases; Medullary thyroid carcinoma; US-guided fine-needle aspiration biopsy