The diagnostic value of calcitonin measurement in wash-out fluid from fine-needle aspiration of thyroid nodules in the diagnosis of medullary thyroid cancer

Objectives: The diagnostic value of calcitonin measurement in fine-needle aspiration biopsy (FNAB) wash-out fluid (Ct-FNAB) for medullary thyroid cancer (MTC) remains to be determined. This prospective study aims to assess the diagnostic value of Ct-FNAB in thyroid nodules in comparison with basal serum calcitonin (Ct), Pentagastrin-stimulated Ct (Pg-sCt), and cytology. Methods: Among patients with goiter addressed to US-FNAB having initial clinical suggestion for thyroidectomy, 27 patients with thyroid nodule/s (n=60), normal, borderline or increased Ct, fulfilled criteria for thyroidectomy. All 27 patients (enrolled according to exclusion/inclusion criteria) underwent ultrasonography (US), Ct, Pg-sCt, US-assisted FNAB of each patient’s nodule for both cytology, and Ct-FNAB before thyroidectomy. Results: Ct-FNAB resulted always >1000 pg/mL in MTC nodules at histology. For values between 36 and 1000 pg/mL, MTCs and nodular or micronodular C-cell Hyperplasia (CCH) results overlapped. Most of the nodules without MTC and/or CCH had Ct-FNAB<17 pg/mL. Ct-FNAB diagnostic power was superior to and similar to other diagnostic procedures (Ct, Pg-sCt, and cytology) in identifying both MTC and CCH, and MTC alone, respectively. Conclusion: The diagnostic power of Ct-FNAB is valuable compared with other routine procedures. Ct-FNAB is highly reliable for the early detection and accurate localization of MTC in thyroid nodules, but it does not differentiate between MTC and CCH. Ct-FNAB is an extremely valuable diagnostic tool, especially considering that other diagnostic procedures do not provide a definitive diagnosis, and it can be included in the clinical work up of thyroid nodules when MTC is suspected.