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Luo Z, Hong Y, Yan C, Ye Q, Wang Y, Huang P. Nomogram for preoperative estimation risk of cervical lymph node metastasis in medullary thyroid carcinoma. Front Oncol 2022; 12:883429. [PMID: 36313643 PMCID: PMC9605736 DOI: 10.3389/fonc.2022.883429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Cervical lymph node metastasis (CLNM) is common in medullary thyroid carcinoma (MTC), but how to manage cervical lymph node involvement of clinically negative MTC is still controversial. This study evaluated the preoperative features and developed an ultrasound (US)-based nomogram to preoperatively predict the CLNM of MTC. Materials and methods A total of 74 patients with histologically confirmed MTC were included in this retrospective study and assigned to the CLNM-positive group and CLNM-negative group based on the pathology. The associations between CLNM and preoperative clinical and sonographic characteristics (size, location, solid component, shape, margin, echogenicity, calcification, and extracapsular invasion of the tumor) were evaluated by the use of univariable and multivariable logistic regression analysis. A nomogram to predict the risk of the CLNM of MTC was built and assessed in terms of discrimination, calibration, and clinical usefulness. Results The nomogram was based on three factors (tumor margin, US-reported suspicious lymph node, and extracapsular invasion US features) and exhibited good discrimination with an area under the curve (AUC) of 0.919 (95% CI, 0.856–0.932). The calibration curves of the nomogram displayed a good agreement between the probability as predicted by the nomogram and the actual CLNM incidence. Conclusions We constructed and validated a US-based nomogram to predict the risk of CLNM in MTC patients, which can be easily evaluated before surgery. This model is helpful for clinical decision-making.
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Affiliation(s)
- Zhiyan Luo
- Department of Ultrasound Medicine, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yurong Hong
- Department of Ultrasound Medicine, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Yurong Hong, ; Pintong Huang,
| | - Caoxin Yan
- Department of Ultrasound Medicine, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qin Ye
- Department of Pathology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yong Wang
- Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Pintong Huang
- Department of Ultrasound Medicine, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Yurong Hong, ; Pintong Huang,
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Park H, Park SY, Park J, Choe JH, Chung MK, Woo SY, Choi JY, Kim SW, Chung JH, Kim TH. Prognostic Value of Preoperative Serum Calcitonin Levels for Predicting the Recurrence of Medullary Thyroid Carcinoma. Front Endocrinol (Lausanne) 2021; 12:749973. [PMID: 34675884 PMCID: PMC8523916 DOI: 10.3389/fendo.2021.749973] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/16/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Serum calcitonin level is a useful biomarker for predicting primary tumor size, the extent of lymph node, and distant metastasis in patients with medullary thyroid carcinoma (MTC). However, the association between preoperative serum calcitonin levels and long-term oncologic outcomes has not yet been established. The aims of this study were to determine the preoperative serum calcitonin cut-off value for predicting disease recurrence and to evaluate its prognostic value. METHODS Patients with MTC (n = 169) who were treated at a tertiary referral hospital in Korea between 1995 and 2019 were enrolled. To determine the preoperative serum calcitonin cut-off value for predicting structural recurrence, the maximum of the standardized log-rank statistics of all possible cut-off values was used. Multivariable Cox regression analysis was used to determine prognostic factors for disease-free survival. RESULTS The overall disease-free survival rate was 75.7%. The preoperative serum calcitonin cut-off value that predicted structural recurrence was 309 pg/mL. Preoperative serum calcitonin levels of > 309 pg/mL were the strongest independent predictor of disease recurrence (hazard ratio (HR) 5.33, 95% confidence interval (85% CI) 1.67-16.96; P = 0.005). Lateral lymph node metastasis (HR 3.70, 95% CI 1.61-8.51; P = 0.002) and positive resection margins (HR 3.57, 95% CI 1.44-8.88; P = 0.006) were also significant predictors of disease recurrence. CONCLUSIONS The preoperative serum calcitonin cut-off value is useful in clinical practice. It is also the best predictive factor for disease-free survival. Preoperative serum calcitonin levels may help determine the optimal postoperative follow-up strategy for patients with MTC.
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Affiliation(s)
- Hyunju Park
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - So Young Park
- Division of Endocrinology, Department of Medicine, Korea University Ansan Hospital, Ansan, South Korea
| | - Jun Park
- Division of Endocrinology, Department of Medicine, Sahmyook Medical Center, Seoul, South Korea
| | - Jun Ho Choe
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sook-Young Woo
- Statistics and Data Center, Samsung Medical Center, Seoul, South Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, and Molecular Imaging, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sun Wook Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Tae Hyuk Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- *Correspondence: Tae Hyuk Kim,
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Guo QQ, Zhang SH, Niu LJ, Zhang YK, Li ZJ, Chang Q. Comprehensive evaluation of medullary thyroid carcinoma before surgery. Chin Med J (Engl) 2019; 132:834-841. [PMID: 30829709 PMCID: PMC6595859 DOI: 10.1097/cm9.0000000000000160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Medullary thyroid carcinoma (MTC) is a rare disease, but it exhibits more aggressive behaviors. The aim of this study was to improve the diagnostic accuracy of MTC before surgery by analyzing the clinical and ultrasonic data of patients with MTC. METHODS The study included 71 patients (96 lesions) with histopathologically proven MTC between April 2011 and September 2016 in the Cancer Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College. The clinical characteristics and sonographic findings were retrospectively reviewed and compared between the ultrasonic correct diagnosis group and the ultrasonic misdiagnosis group with the t test or Mann-Whitney U test for quantitative parameters and the χ test or Fisher exact test for qualitative parameters. RESULTS Compared with the ultrasonic correct diagnosis group, the proportion of the cystic change in the ultrasonic misdiagnosed group was high (25.0% vs. 4.2%), the uncircumscribed margin and irregular shape proportions were low (20.8%, 58.3% vs. 74.7%, 87.3%), calcification was relatively rare (20.8% vs. 56.3%), and rich vascularity was relatively rare (25.0% vs. 78.9%). CONCLUSIONS In the case of atypical MTC, such as cystic change, circumscribed margin, regular shape, no calcification, no rich vascularity, and normal cervical lymph nodes, MTC is easily misdiagnosed as benign by ultrasound. Therefore, ultrasound, cytology and serum calcitonin should be comprehensively evaluated for a preoperative diagnosis of MTC.
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Affiliation(s)
- Qian-Qian Guo
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shao-Hang Zhang
- Department of Ultrasound, Beijing Haidian Hospital, Haidian Section of Peking University Third Hospital, Beijing 100080, China
| | - Li-Juan Niu
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yu-Kang Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Zheng-Jiang Li
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qing Chang
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Liu MJ, Liu ZF, Hou YY, Men YM, Zhang YX, Gao LY, Liu H. Ultrasonographic characteristics of medullary thyroid carcinoma: a comparison with papillary thyroid carcinoma. Oncotarget 2018; 8:27520-27528. [PMID: 28460476 PMCID: PMC5432354 DOI: 10.18632/oncotarget.15897] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 02/20/2017] [Indexed: 12/01/2022] Open
Abstract
This study was designed to explore differences in the ultrasonographic characteristics of medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC). This study included 35 cases of MTC and 96 cases of PTC that were surgically and pathologically confirmed. Preoperative ultrasound images were retrospectively reviewed by two physicians (with 5 years’ experience in thyroid ultrasound) under the premise of unknown pathological results. Various ultrasonic features of nodules were assessed objectively. The clinical features of components were determined by other physicians. Age, sex, unilateral or bilateral involvement of thyroid gland, lesion size, margin, shape, echogenicity, calcification, intranodular blood flow, cervical lymph node, and tumor node metastasis (TNM) stage were compared between MTC and PTC groups. Age, sex, involvement of the thyroid gland, margin, and calcification were similar for the MTC and PTC groups. Compared with the PTC group, the lesion size in the MTC group was significantly larger (P < 0.001). A taller-than-wide shape (aspect ratio > 1) was significantly less likely in the MTC group than the PTC group (P < 0.001). A mixed echogenicity was significantly more common in the MTC group than the PTC group (P = 0.003). The MTC group had significantly enhanced intranodular blood flow (P < 0.001). The TNM stage of the MTC group was significantly higher than that of PTC group (P = 0.001). Medullary thyroid carcinomas differ significantly from PTCs in lesion size, shape, echogenicity, and intranodular blood flow.
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Affiliation(s)
- Mei-Juan Liu
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Zhong-Feng Liu
- Department of Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - Yuan-Yuan Hou
- Department of Obstetrics and Gynecology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Yan-Ming Men
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Yu-Xi Zhang
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Ling-Yun Gao
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Hao Liu
- Department of Ultrasound, Yantai Hospital of Traditional Chinese Medicine, Yantai, Shandong, China
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Aubert S, Berdelou A, Gnemmi V, Behal H, Caiazzo R, D'herbomez M, Pigny P, Wemeau JL, Carnaille B, Renaud F, Bouchindhomme B, Leteurtre E, Perrais M, Pattou F, Do Cao C. Large sporadic thyroid medullary carcinomas: predictive factors for lymph node involvement. Virchows Arch 2018; 472:461-468. [PMID: 29388012 DOI: 10.1007/s00428-018-2303-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 01/01/2018] [Accepted: 01/18/2018] [Indexed: 12/27/2022]
Abstract
Lymph node involvement (LNI) is one of the most important prognostic factors for poor survival in medullary thyroid carcinoma (MTC). At diagnosis, LNI is found in over 50% of sporadic MTCs, and especially in large tumours. Cervical lymph node dissection is therefore mandatory during MTC surgery. However, some large tumours (responsible for high preoperative basal calcitonin levels) are found to lack LNI, and can be cured definitely. Preoperative detection of these particular tumours might spare patients from undergoing extensive cervical dissection. The objective of the present retrospective study of a series of large sporadic MTCs was to identify clinical, biological and pathological factors that were predictive of LNI. Consecutive cases of large, sporadic MTCs (measuring at least 1 cm in diameter) were retrieved and reviewed. The levels of several mature microRNAs (miRs) in paraffin-embedded samples were assessed using qPCR. Of the 54 MTCs, 26 had LNI and 28 were pN0. Relative to pN0 patients, patients with LNI had a significant higher preoperative basal calcitonin level (p = 0.0074) and a greater prevalence of infiltrative margins (p < 0.0001), lymphovascular invasion (p = 0.0004), extrathyroidal extension (p < 0.0001), a higher pT stage (p = 0.0003) and more abundant desmoplastic stroma (p = 0.0006). Tumour expression levels of miR-21 (p = 0.0008) and miR-183 (p = 0.0096) were higher in the LNI group. The abundance of desmoplastic stroma (p = 0.007) and the miR-21 expression level (p = 0.0026) were independent prognostic factors for LNI. The abundance of desmoplastic stroma and high levels of miR-21 expression were strong indicators of LNI, and may thus help the surgeon to choose the extent of cervical lymph node dissection for large, sporadic MTCs with no preoperatively obvious LNI.
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Affiliation(s)
- Sébastien Aubert
- Institut de Pathologie, Centre de Biologie Pathologie, CHRU de Lille, 59037, Lille, France.
- Faculté de Médecine, Université de Lille, 59045, Lille, France.
- UMR 1172, INSERM Bâtiment Biserte, JPArc, 59045, Lille, France.
| | - Amandine Berdelou
- Service de Cancérologie endocrinienne, IGR, 94805, Villejuif, Paris, France
| | - Viviane Gnemmi
- Institut de Pathologie, Centre de Biologie Pathologie, CHRU de Lille, 59037, Lille, France
- Faculté de Médecine, Université de Lille, 59045, Lille, France
- UMR 1172, INSERM Bâtiment Biserte, JPArc, 59045, Lille, France
| | - Hélène Behal
- Unité de Biostatistiques - Pôle de Santé Publique, CHRU de Lille, 59037, Lille, France
| | - Robert Caiazzo
- Faculté de Médecine, Université de Lille, 59045, Lille, France
- Service de Chirurgie Endocrine, Hôpital Huriez, CHRU de Lille, 59037, Lille, France
| | - Michèle D'herbomez
- Institut de Biochimie, Centre de Biologie Pathologie Génétique, CHRU de Lille, 59037, Lille, France
| | - Pascal Pigny
- Faculté de Médecine, Université de Lille, 59045, Lille, France
- UMR 1172, INSERM Bâtiment Biserte, JPArc, 59045, Lille, France
- Institut de Biochimie, Centre de Biologie Pathologie Génétique, CHRU de Lille, 59037, Lille, France
| | - Jean Louis Wemeau
- Faculté de Médecine, Université de Lille, 59045, Lille, France
- Service d'Endocrinologie, Hôpital Huriez, CHRU de Lille, 59037, Lille, France
| | - Bruno Carnaille
- Faculté de Médecine, Université de Lille, 59045, Lille, France
- Service de Chirurgie Endocrine, Hôpital Huriez, CHRU de Lille, 59037, Lille, France
| | - Florence Renaud
- Institut de Pathologie, Centre de Biologie Pathologie, CHRU de Lille, 59037, Lille, France
- Faculté de Médecine, Université de Lille, 59045, Lille, France
- UMR 1172, INSERM Bâtiment Biserte, JPArc, 59045, Lille, France
| | - Brigitte Bouchindhomme
- Institut de Pathologie, Centre de Biologie Pathologie, CHRU de Lille, 59037, Lille, France
| | - Emmanuelle Leteurtre
- Institut de Pathologie, Centre de Biologie Pathologie, CHRU de Lille, 59037, Lille, France
- Faculté de Médecine, Université de Lille, 59045, Lille, France
- UMR 1172, INSERM Bâtiment Biserte, JPArc, 59045, Lille, France
| | - Michael Perrais
- Faculté de Médecine, Université de Lille, 59045, Lille, France
- UMR 1172, INSERM Bâtiment Biserte, JPArc, 59045, Lille, France
| | - François Pattou
- Faculté de Médecine, Université de Lille, 59045, Lille, France
- Service de Chirurgie Endocrine, Hôpital Huriez, CHRU de Lille, 59037, Lille, France
| | - Christine Do Cao
- Service d'Endocrinologie, Hôpital Huriez, CHRU de Lille, 59037, Lille, France
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De Crea C, Raffaelli M, Milano V, Carrozza C, Zuppi C, Bellantone R, Lombardi CP. Intraoperative high-dose calcium stimulation test in patients with sporadic medullary thyroid carcinoma is highly accurate in predicting lateral neck metastases. Surgery 2015; 159:70-6. [PMID: 26456123 DOI: 10.1016/j.surg.2015.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 05/14/2015] [Accepted: 08/12/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Intraoperative measurement of calcitonin is not highly accurate in predicting the completeness of the operative resection after total thyroidectomy combined with central neck dissection (TT-CND) in patients with medullary thyroid carcinoma (MTC). We evaluated whether an intraoperative, high-dose calcium stimulation test (IO-CST) after TT-CND can predict lateral neck involvement. METHODS Eleven patients who underwent primary operation for sporadic MTC were included. High-dose (25 mg/kg) calcium gluconate was administered after TT-CND with calcitonin measured at 2, 5, and 10 minutes after the calcium gluconate infusion. RESULTS There were 2 males and 9 females (mean age, 51 years; range, 18-88). Three patients showed lateral neck metastases. At a mean follow-up of 7.0 months (range, 2-10), 1 patient showed distant metastases and 1 a slightly increased calcitonin level. After IO-CST, serum calcitonin increased in all the 3 patients with lateral neck metastases, and it remained unchanged or decreased in the other patients without lateral neck metastases. Percent variation of serum calcitonin after IO-CST was 92% in patients with lateral neck metastases and -3.1 ± 4.9% in patients without lateral neck metastases. CONCLUSION Calcitonin measurement after IO-CST in patients with sporadic MTC can be highly accurate in predicting lateral neck nodes involvement. These results could represent a stimulus toward the development of a quick calcitonin assay.
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Affiliation(s)
- Carmela De Crea
- U.O. Chirurgia Endocrina e Metabolica, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Raffaelli
- U.O. Chirurgia Endocrina e Metabolica, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Valentina Milano
- U.O. Chirurgia Endocrina e Metabolica, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cinzia Carrozza
- U.O. Analisi Ormonali e Biologia Molecolare Clinica, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cecilia Zuppi
- U.O. Analisi Ormonali e Biologia Molecolare Clinica, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rocco Bellantone
- U.O. Chirurgia Endocrina e Metabolica, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Celestino Pio Lombardi
- U.O. Chirurgia Endocrina e Metabolica, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
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Lairmore TC, Diesen D, Goldfarb M, Milas M, Ying AK, Sharma J, McIver B, Wong RJ, Randolph G. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE CLINICAL REVIEW: TIMING OF MULTIPLE ENDOCRINE NEOPLASIA THYROIDECTOMY AND EXTENT OF CENTRAL NECK LYMPHADENECTOMY. Endocr Pract 2015; 21:839-47. [PMID: 26172129 DOI: 10.4158/ep14463.dscr] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Ha EJ, Baek JH, Na DG, Kim JH, Kim JK, Min HS, Song DE, Lee KE, Shong YK. The Role of Core Needle Biopsy and Its Impact on Surgical Management in Patients with Medullary Thyroid Cancer: Clinical Experience at 3 Medical Institutions. AJNR Am J Neuroradiol 2015; 36:1512-7. [PMID: 25929882 DOI: 10.3174/ajnr.a4317] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 01/04/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE Medullary thyroid carcinoma is an uncommon malignancy that is challenging to diagnose. Our aim was to present our experience using core needle biopsy for the diagnosis of medullary thyroid carcinoma compared with fine-needle aspiration. MATERIALS AND METHODS Between January 2000 and March 2012, 202 thyroid nodules in 191 patients were diagnosed as medullary thyroid cancer by using sonography-guided fine-needle aspiration, core needle biopsy, or surgery. One hundred eighty-three thyroid nodules in 172 patients were included on the basis of the final diagnosis. We evaluated the sensitivity and positive predictive value of fine-needle aspiration and core needle biopsy for the diagnosis of medullary thyroid cancer. We compared the rate of a delayed diagnosis, a diagnostic surgery, and surgery with an incorrect diagnosis for fine-needle aspiration and core needle biopsy and investigated the factors related to the fine-needle aspiration misdiagnosis of medullary thyroid cancer. RESULTS Fine-needle aspiration showed 43.8% sensitivity and 85.1% positive predictive value for the diagnosis of medullary thyroid cancer; 25.7% (44/171) of patients had a delayed diagnosis, while 18.7% (32/171) underwent an operation for accurate diagnosis, and 20.5% (35/171) underwent an operation with an incorrect diagnosis. Core needle biopsy achieved 100% sensitivity and positive predictive value without a delay in diagnosis (0/22), the need for a diagnostic operation (0/22), or an operation for an incorrect diagnosis (0/22). A calcitonin level of <100 pg/mL was the only significant factor for predicting the fine-needle aspiration misdiagnosis of medullary thyroid cancer (P = .034). CONCLUSIONS Core needle biopsy showed a superior sensitivity and positive predictive value to fine-needle aspiration and could optimize the surgical management in patients with medullary thyroid cancer. Because the ability of fine-needle aspiration to diagnose medullary thyroid cancer significantly decreases in patients with serum calcitonin levels of <100 pg/mL, core needle biopsy could be indicated for these patients to optimize their surgical management.
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Affiliation(s)
- E J Ha
- From the Department of Radiology and the Research Institute of Radiology (E.J.H., J.H.B) Department of Radiology (E.J.H.), Ajou University School of Medicine, Suwon, Korea
| | - J H Baek
- From the Department of Radiology and the Research Institute of Radiology (E.J.H., J.H.B)
| | - D G Na
- Department of Radiology (D.G.N.), Human Medical Imaging and Intervention Center, Seoul, Korea Healthcare System Gangnam Center (D.G.N.), Seoul National University Hospital, Seoul, Korea
| | - J-h Kim
- Departments of Radiology (J.-h.K.)
| | - J K Kim
- Department of Radiology (J.K.K.), Chung-Ang University College of Medicine, Seoul, Korea
| | | | - D E Song
- Departments of Pathology (D.E.S.)
| | - K E Lee
- Surgery (K.E.L.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Y K Shong
- Metabolism and Endocrinology (Y.K.S.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Is Intraoperative Calcitonin Monitoring Useful to Modulate the Extension of Neck Dissection in Patients With Medullary Thyroid Carcinoma? World J Surg 2013; 38:568-75. [DOI: 10.1007/s00268-013-2328-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Jarzab B, Feldt-Rasmussen U. Introduction to European comments on "Medullary Thyroid Cancer: management guidelines of the American Thyroid Association". Thyroid Res 2013; 6 Suppl 1:S1. [PMID: 23514266 PMCID: PMC3599712 DOI: 10.1186/1756-6614-6-s1-s1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Guest Editors of Thyroid Research supplement devoted to medullary thyroid cancer present the history on how the discussion about "Medullary Thyroid Cancer: management guidelines of the American Thyroid Association" was initiated and subsequently widely commented before and during European Thyroid Association - Cancer Research Network Meeting in Lisbon. It is explained why it has been decided to publish the manuscripts within the supplement - to document voices from the discussion and popularize them.
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Affiliation(s)
- Barbara Jarzab
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
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