Diagnostic Challenges of Medullary Thyroid Carcinoma

被引:20
|
作者
Leimbach, Robert D. [1 ,2 ]
Hoang, Thanh D. [1 ,2 ]
Shakir, Mohamed K. M. [1 ,2 ]
机构
[1] Walter Reed Natl Mil Med Ctr, Dept Med, Div Endocrinol, Bethesda, MD 20814 USA
[2] Uniformed Serv Univ Hlth Sci, Bethesda, MD 20814 USA
关键词
Medullary thyroid cancer; Diagnostic challenges; Imaging; Calcitonin;
D O I
10.1159/000515373
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Medullary thyroid carcinoma (MTC) comprises 1-2% of all thyroid cancers, yet 15% of all thyroid cancer-related deaths. While up to 20% of cases may be predicted due to autosomal dominant germline mutations, 80% of cases are sporadic. However, due to non-specific presenting symptoms and diagnostic imaging, prompt diagnosis and treatment has remained elusive. This article will further investigate the limitations of MTC diagnosis and look into future areas for diagnostic improvement. Methods: Relevant articles were identified using a systematic PubMed and Google Scholar search. Results: Prophylactic total thyroidectomy for the 20% of MTC cases that are present in autosomal dominant disorder provides definitive treatment. Serum calcitonin (Ctn) screening has several technical limitations due to population variability and laboratory assay interference, but advances in laboratory technology and combined use with fine needle aspiration increase its sensitivity. Other serum assays such as carcinoembryonic antigen and procalcitonin have limited applicability. Thyroid ultrasound remains the gold standard for the initial diagnostic planning, with limited application for CT, MRI, and PET imaging. Conclusion: With complete surgical resection the only definitive treatment, early MTC diagnosis has presented an elusive challenge, mainly due to its relative rarity and difficulty in finding an economic screening strategy. Careful family history combined with fine needle aspiration with serum Ctn analysis can improve diagnostic sensitivity and specificity to greater than 95%.
引用
收藏
页码:422 / 432
页数:11
相关论文
共 50 条
  • [21] MEDULLARY CARCINOMA OF THE THYROID
    PACHES, AI
    PROPP, RM
    ABDULLIN, NA
    ANOKHIN, BM
    VOPROSY ONKOLOGII, 1982, 28 (05) : 77 - 82
  • [22] MEDULLARY CARCINOMA OF THE THYROID
    VERDY, M
    UNION MEDICALE DU CANADA, 1983, 112 (12): : 1122 - 1123
  • [23] Medullary thyroid carcinoma
    Hejna, M
    Brodowicz, T
    Kornek, GV
    ONKOLOGIE, 1998, 21 (04): : 334 - 337
  • [24] MEDULLARY CARCINOMA OF THE THYROID
    MILHAUD, G
    BULLETIN DU CANCER, 1984, 71 (02) : 111 - 113
  • [25] MEDULLARY THYROID CARCINOMA
    Griebeler, Marcio L.
    Gharib, Hossein
    Thompson, Geoffrey B.
    ENDOCRINE PRACTICE, 2013, 19 (04) : 703 - 711
  • [26] Medullary thyroid carcinoma
    Modigliani, E
    REVUE DE MEDECINE INTERNE, 1999, 20 (06): : 490 - 503
  • [27] Medullary thyroid carcinoma
    Hoff, Ana O.
    Hoff, Paulo M.
    HEMATOLOGY-ONCOLOGY CLINICS OF NORTH AMERICA, 2007, 21 (03) : 475 - +
  • [28] MEDULLARY CARCINOMA OF THYROID
    MELVIN, KEW
    PHARMACOLOGY & THERAPEUTICS PART C-CLINICAL PHARMACOLOGY AND THERAPEUTICS, 1976, 1 (1-2): : 183 - 205
  • [29] MEDULLARY CARCINOMA OF THYROID
    JAQUES, C
    SCHWEIZERISCHE MEDIZINISCHE WOCHENSCHRIFT, 1974, 104 (16) : 565 - 570
  • [30] MEDULLARY CARCINOMA OF THE THYROID
    MARTIN, TJ
    MEDICAL JOURNAL OF AUSTRALIA, 1979, 1 (05) : 157 - 158