| Autor: |
Cavallo AC; Department of Endocrinology, Hospital Universitario Austral, Buenos Aires, Argentina.; Department of Endocrinology, Sanatorio Las Lomas, Buenos Aires, Argentina.; Department of Endocrinology and Hospital Alta Complejidad, Formosa, Argentina., Pitoia F; Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, Buenos Aires, Argentina., Roberti J; Centre for Research in Epidemiology and Public Health (CIESP) - National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina., Brenzoni P; Department of Endocrinological Biochemistry Service, Hospital Universitario Austral, Buenos Aires, Argentina., Lencioni M; Department of Pathology, Hospital Alta Complejidad, Formosa, Argentina.; Department of Pathology, and Hospital Universitario Austral, Buenos Aires, Argentina.; Department of Pathology, and Sanatorio Las Lomas, Buenos Aires, Argentina., Jaroslavsky MJ; Department of Pathology, and Sanatorio Las Lomas, Buenos Aires, Argentina., Spengler E; Department of Pathology, and Hospital Universitario Austral, Buenos Aires, Argentina., Voogd A; Department of Head and Neck Surgery, Hospital Universitario Austral, Buenos Aires, Argentina.; Department of Head and Neck Surgery, Sanatorio Las Lomas, Buenos Aires, Argentina.; Department of Academic Development, School of Biomedical Sciences, Hospital Universitario Austral, Universidad Austral, Buenos Aires, Argentina., Firpo C; Department of Endocrinology, Sanatorio Las Lomas, Buenos Aires, Argentina., Saco P; Department of Head and Neck Surgery, Hospital Universitario Austral, Buenos Aires, Argentina., Piñero F; Department of Academic Development, School of Biomedical Sciences, Hospital Universitario Austral, Universidad Austral, Buenos Aires, Argentina., Negueruela M; Department of Endocrinology, Hospital Universitario Austral, Buenos Aires, Argentina. |
| Abstrakt: |
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 ratio of 1:2. 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). The median serum Ctn value was significantly higher in cases (525 pg/mL [interquartile range (IQR), 162.5-1.200]) than in controls (1.6 pg/mL [IQR, 0.5-5.6]; p < 0.001). The median FNA-Ctn value was significantly higher in MTC nodules (3.100 pg/mL [IQR, 450-45,200]) than in non-MTC nodules (0.5 pg/mL [IQR, 0.5-0.5]; p < 0.0001). In 11 MTC patients with multinodular goiter, the FNA-Ctn value was significantly higher in non-medullary nodules located in the same lobe where an MTC nodule was diagnosed ( p = 0.0002). Overall, the FNA-Ctn AUROC was 0.99 [95% confidence interval, 0.98-1.0], and a threshold of ≥220 pg/mL showed 100% sensitivity and 98% specificity for MTC diagnosis. Conclusions: The use of FNA-Ctn measured by ECLIA showed adequate diagnostic accuracy for MTC diagnosis. Moreover, it may be clinically useful for localization in multinodular goiter when lobectomy is considered. Clinical Trial Registration: Clinicaltrials.gov NCT06067594. |
