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Meta-Analysis
. 2022 Jan;75(1):33-39.
doi: 10.1007/s12020-021-02892-x. Epub 2021 Oct 4.

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

Pierpaolo Trimboli  1   2 , Jacopo Giannelli  3 , Bernardo Marques  4 , Arnoldo Piccardo  5 , Anna Crescenzi  6 , Maurilio Deandrea  7
Affiliations
Meta-Analysis

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

Pierpaolo Trimboli et al. Endocrine. 2022 Jan.

Abstract

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-to-head 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.

Keywords: Calcitonin; Cytology; FNA; Medullary thyroid cancer; Meta-analysis; Washout.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow of search of articles
Fig. 2
Fig. 2
Pooled sensitivity of FNA-cytology. Diamond indicates the pooled sensitivity. Square size indicates the sample. Line indicates 95% CI
Fig. 3
Fig. 3
Pooled sensitivity of FNA-CT. Diamond indicates the pooled sensitivity. Square size indicates the sample. Line indicates 95% CI
Fig. 4
Fig. 4
Ultrasound presentation of one case of MTC. The nodule is placed in the right thyroid lobe and presents as mixed with isoechoic and anechoic parts, mildly vascularized, with largest diameter of 44 mm.
See this image and copyright information in PMC

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