Limitations of preoperative cytology for medullary thyroid cancer: Proposal for improved preoperative diagnosis for optimal initial medullary thyroid carcinoma specific surgery

Alan D Workman; Selen Soylu; Dipti Kamani; Anahita Nourmahnad; Natalia Kyriazidis; Ryan Saade; Yin Ren; Lori Wirth; William C Faquin; Ayşe M Onenerk; Yuri E Nikiforov; Zaid Al-Qurayshi; Emad Kandil; Richard T Kloos; Leslie Eldeiry; Carrie Lubitz; Nikolaos Stathatos; Gregory W Randolph

doi:10.1002/hed.26550

Limitations of preoperative cytology for medullary thyroid cancer: Proposal for improved preoperative diagnosis for optimal initial medullary thyroid carcinoma specific surgery

Head Neck. 2021 Mar;43(3):920-927. doi: 10.1002/hed.26550. Epub 2020 Dec 2.

Authors

Alan D Workman¹, Selen Soylu¹, Dipti Kamani¹, Anahita Nourmahnad², Natalia Kyriazidis¹, Ryan Saade¹, Yin Ren¹, Lori Wirth³, William C Faquin⁴, Ayşe M Onenerk⁵, Yuri E Nikiforov⁶, Zaid Al-Qurayshi⁷, Emad Kandil⁸, Richard T Kloos⁹, Leslie Eldeiry¹⁰, Carrie Lubitz^{11

12}, Nikolaos Stathatos¹³, Gregory W Randolph^{1

14}

Affiliations

¹ Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, USA.
² Harvard Medical School, Boston, Massachusetts, USA.
³ Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁴ Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
⁵ Department of Pathology, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey.
⁶ Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
⁷ Department of Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
⁸ Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
⁹ Department of Medical Affairs, Veracyte Inc., South San Francisco, California, USA.
¹⁰ Harvard Vanguard Medical Associates, Atrius Health, Boston, Massachusetts, USA.
¹¹ Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
¹² Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA.
¹³ Thyroid Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
¹⁴ Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.

PMID: 33269526
DOI: 10.1002/hed.26550

Abstract

Background: Preoperative diagnosis of medullary thyroid carcinoma (MTC) is often difficult, given the poor sensitivity of fine-needle aspiration (FNA) cytology for MTC. This study investigates this issue and presents recommendations for improving preoperative diagnostic paradigms in MTC cases.

Design/method: Histopathologically confirmed MTC patients with preoperative cytologic assessment of index nodules were enrolled. FNA diagnosis, final pathology, and surgery details were collected.

Results: Out of 71 patients, 49 (69%) were diagnosed by FNA as either definitive MTC (35, 49%) or suspected MTC (14, 20%) and 22 (31%) patients had no indication of MTC on FNA.

Conclusion: In a tertiary-care setting, one-third of subjects had an FNA interpretation that did not suggest the possibility of MTC. The limitations of preoperative diagnosis are especially problematic for MTC as they can cause delayed or incomplete treatment. Additional testing is proposed to improve preoperative diagnosis and surgical care of MTC patients.

Keywords: MTC; MTC detection; cytology; medullary thyroid cancer; optimal surgery; preoperative diagnosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Biopsy, Fine-Needle
Carcinoma, Neuroendocrine* / pathology
Carcinoma, Neuroendocrine* / surgery
Cytodiagnosis
Humans
Thyroid Neoplasms* / pathology
Thyroid Neoplasms* / surgery
Thyroid Nodule* / pathology
Thyroid Nodule* / surgery