Journal article

Head-to-head comparison of FNA cytology vs. calcitonin measurement in FNA washout fluids (FNA-CT) to diagnose medullary thyroid carcinoma : a systematic review and meta-analysis

  • Trimboli, Pierpaolo Servizio di Endocrinologia e Diabetologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland - Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland
  • Giannelli, Jacopo Division of Endocrinology, Diabetes and Metabolism, Department of Medical Science, University of Turin, Turin, Italy
  • Marques, Bernardo Endocrinology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
  • Piccardo, Arnoldo Nuclear Medicine Department, Ente Ospedaliero “Ospedali Galliera”, Genoa, Italy
  • Crescenzi, Anna Department of Pathology, University Hospital Campus Bio-Medico, Rome, Italy
  • Deandrea, Maurilio UO Endocrinologia, Diabetologia e Malattie del metabolismo, AO Ordine Mauriziano Torino, Torino, Italy
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  • Endocrine. - Springer. - 2022, no. 75, p. 33–39
English Purpose: The sensitivity of cytology after fine needle aspiration (FNA-cytology) in detecting medullary thyroid carcinoma (MTC) is low. To overcome this problem, measuring calcitonin (CT) in washout fluid of FNA (FNA-CT) has been largely diffused and showed good performance. However, no evidence-based study exists comparing systematically the sensitivity of FNA-cytology and FNA-CT. This study aimed to systematically review the literature and collect data allowing a head-tohead comparison meta-analysis between FNA- cytology and FNA-CT in detecting MTC lesions. Methods: The online databases of PubMed/MEDLINE and Scopus were searched until June 2021. Original articles reporting the use of both FNA-cytology and FNA-CT in the same series of histologically proven MTC lesions were included They were extracted general features of each study, number of MTC lesions (nodule and neck lymph nodes), and true positive and false negatives of both FNA-cytology and FNA-CT. Results: Six studies were included. The sensitivity of FNA- cytology varied from 20% to 86% with a pooled value of 54% (95% CI 35–73%) and significant heterogeneity. The sensitivity of FNA- CT was higher than 95% in almost all studies with a pooled value of 98% (95% CI 96–100%) without heterogeneity. The sensitivity of FNA-CT was significantly higher than that of FNA-cytology. Conclusions: FNA-CT is significantly more sensitive than FNA-cytology in detecting MTC. Accordingly, FNA-CT represents the standard method to use in patients with suspicious MTC lesions, combined with cytology.
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