FINE NEEDLE ASPIRATION and MEDULLARY THYROID CARCINOMA: the RISK of INADEQUATE PREOPERATIVE EVALUATION and INITIAL SURGERY WHEN RELYING UPON FNAB CYTOLOGY ALONE

FINE NEEDLE ASPIRATION and MEDULLARY THYROID CARCINOMA: the RISK of INADEQUATE PREOPERATIVE EVALUATION and INITIAL SURGERY WHEN RELYING UPON FNAB CYTOLOGY ALONE

Author Essig, Garth F. Google Scholar
Porter, Kyle Google Scholar
Schneider, David Google Scholar
Debora, Arpaia Google Scholar
Lindsey, Susan C. Autor UNIFESP Google Scholar
Busonero, Giulia Google Scholar
Fineberg, Daniel Google Scholar
Fruci, Barbara Google Scholar
Boelaert, Kristien Google Scholar
Smit, Johannes W. Google Scholar
Meijer, Johannes Arnoldus Anthonius Google Scholar
Duntas, Leonidas Google Scholar
Sharma, Neil Google Scholar
Costante, Giuseppe Google Scholar
Filetti, Sebastiano Google Scholar
Sippel, Rebecca S. Google Scholar
Biondi, Bernadette Google Scholar
Topliss, Duncan J. Google Scholar
Pacini, Furio Google Scholar
Maciel, Rui M. B. Autor UNIFESP Google Scholar
Walz, Patrick C. Google Scholar
Kloos, Richard T. Google Scholar
Institution Ohio State Univ
Univ Wisconsin
Univ Naples Federico II
Universidade Federal de São Paulo (UNIFESP)
Univ Siena
Monash Univ
Univ Catanzaro Magna Graecia
Univ Birmingham
Radboud Univ Nijmegen
Albert Schweitzer Hosp
Univ Athens
Inst Jules Bordet
Univ Roma La Sapienza
Abstract Objectives: 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.Conclusion: 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.
Language English
Date 2013-11-01
Published in Endocrine Practice. Jacksonville: Amer Assoc Clinical Endocrinologists, v. 19, n. 6, p. 920-927, 2013.
ISSN 1530-891X (Sherpa/Romeo, impact factor)
Publisher Amer Assoc Clinical Endocrinologists
Extent 920-927
Origin http://dx.doi.org/10.4158/EP13143.OR
Access rights Closed access
Type Article
Web of Science ID WOS:000327645900011
URI http://repositorio.unifesp.br/handle/11600/36970

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