Serum calcitonin measurements in the preoperative diagnosis of medullary thyroid carcinoma

Ellen Marqusee

This article has no abstract so we have provided the first paragraph of the full text.

Approximately 3–5% of all thyroid carcinomas are diagnosed as MTC. Hereditary MTC accounts for 25% of cases, and occurs as part of either familial MTC or multiple endocrine neoplasia type 2. Individuals at risk of hereditary MTC can be identified by screening for germline mutations in the RET proto-oncogene. The remaining 75% of MTC cases are sporadic, and are typically diagnosed when the patient presents with an asymptomatic thyroid nodule. Patients with sporadic MTC often have lymph-node or distant metastases at the time of diagnosis, and their prognosis is relatively poor. The overall 10-year survival rate is 50–60%; however, patients with small tumors and limited tumor spread at the time of initial treatment have a more favorable prognosis. MTC is usually diagnosed by FNAC but the cytologic features can be misleading, and the nodule can be misdiagnosed if MTC is not suspected.¹ Calcitonin immunostaining should be performed, therefore, when the cytologic findings are unclear. In addition, small sporadic tumors (<1 cm) can be missed because nodules of this size are not usually aspirated.

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