Optimizing Diagnostic Accuracy of Fine Needle Aspiration Biopsy Calcitonin Measurements in Detecting Medullary Thyroid Carcinoma

CAVALLO, ANDREA CAMILA; PITOIA, FABIÁN; ROBERTI, JAVIER; BRENZONI, PABLO; LENCIONI, MELISA; JAROSLAVSKY, MARIA JOSE; SPENGLER, EUNICE; VOOGD, ANA; FIRPO, CLAUDIA; SACO, PEDRO; PIÑERO, FEDERICO; NEGUERUELA, MARIA

THYROID

MARY ANN LIEBERT INC

Lugar: New York; Año: 2023

1050-7256

Background: The optimal cutoff value of calcitonin (Ctn) levels measured using an electrochemiluminescence immunoassay (ECLIA) obtained from the washout fluid of fine-needle aspiration (FNA-Ctn) for the diagnosis of medullary thyroid carcinoma (MTC) is currently not established. We evaluated the diagnostic accuracy and clinical utility of FNA-Ctn for the diagnosis and location of MTC in patients with nodular or multinodular goiters.Methods: This was a case-control study nested on a prospective multicenter cohort of patients with nodular or multinodular goiter, normal or elevated serum Ctn, and thyroidectomy indications. Ctn and FNA-Ctn were measured using ECLIA methodology before surgery. From this nested cohort, MTC cases and controls (non-medullary pathology) were identified from the final pathological analysis. Cumulative incidence sampling of controls was randomly performed at a 1:2 ratio. Sensitivity, specificity, and area under the receiver operator curve (AUROC) were calculated for patients and the total number of thyroid nodules.Results: From 1272 patients included in the prospective cohort, 50 MTC cases and 105 controls were included. In this study, 286 thyroid nodules were evaluated (63 MTC and 223 non-MTCs). Median serum Ct was significantly higher in cases [525 pg/mL (IQR, 162.5 - 1.200)] than in controls [1.6 pg/mL (0.5 - 5.6); P