Please use this identifier to cite or link to this item: http://repositorio.unifesp.br/handle/11600/36970
Title: FINE NEEDLE ASPIRATION and MEDULLARY THYROID CARCINOMA: the RISK of INADEQUATE PREOPERATIVE EVALUATION and INITIAL SURGERY WHEN RELYING UPON FNAB CYTOLOGY ALONE
Authors: Essig, Garth F.
Porter, Kyle
Schneider, David
Debora, Arpaia
Lindsey, Susan C. [UNIFESP]
Busonero, Giulia
Fineberg, Daniel
Fruci, Barbara
Boelaert, Kristien
Smit, Johannes W.
Meijer, Johannes Arnoldus Anthonius
Duntas, Leonidas
Sharma, Neil
Costante, Giuseppe
Filetti, Sebastiano
Sippel, Rebecca S.
Biondi, Bernadette
Topliss, Duncan J.
Pacini, Furio
Maciel, Rui M. B. [UNIFESP]
Walz, Patrick C.
Kloos, Richard T.
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
Issue Date: 1-Nov-2013
Publisher: Amer Assoc Clinical Endocrinologists
Citation: Endocrine Practice. Jacksonville: Amer Assoc Clinical Endocrinologists, v. 19, n. 6, p. 920-927, 2013.
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.
URI: http://repositorio.unifesp.br/handle/11600/36970
ISSN: 1530-891X
Other Identifiers: http://dx.doi.org/10.4158/EP13143.OR
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