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. 2024 Jan 2;16(1):210.
doi: 10.3390/cancers16010210.

Diffuse C-Cells Hyperplasia Is the Source of False Positive Calcitonin Measurement in FNA Washout Fluids of Thyroid Nodules: A Rational Clinical Approach to Avoiding Unnecessary Surgery

Chiara Mura  1 , Rossella Rodia  1 , Silvia Corrias  1 , Antonello Cappai  1 , Maria Letizia Lai  2 , Gian Luigi Canu  3 , Fabio Medas  3 , Pietro Giorgio Calò  3 , Stefano Mariotti  1 , Francesco Boi  1
Affiliations

Diffuse C-Cells Hyperplasia Is the Source of False Positive Calcitonin Measurement in FNA Washout Fluids of Thyroid Nodules: A Rational Clinical Approach to Avoiding Unnecessary Surgery

Chiara Mura et al. Cancers (Basel). .

Abstract

Purpose: The FNA-CT is useful for the diagnosis of MTC. The aim of this study was to evaluate the performance of FNA-CT in TNs coexisting with CCH.

Methods: This study retrospectively reviewed the records of 11 patients with TNs submitted to thyroidectomy on the basis of elevated basal and/or stimulated serum CT values, which at histology were not confirmed to be MTC. The results obtained in this group were compared with those of a previously reported group of histologically proven MTC patients submitted to an identical presurgical evaluation. All patients, negative for known mutations in the RET proto-oncogene, were preoperatively submitted to neck ultrasound, FNA-cytology, and FNA-CT.

Results: Approximately 6 of 11 patients showed increased (>36 ng/mL, as established in previous studies not involving patients with CCH) FNA-CT. All these patients showed diffuse CCH at histology in the thyroid lobe submitted to FNA; 5 of them were benign at histology, while only one was malignant (papillary thyroid carcinoma, PTC). The remaining 5 of 11 patients had low FNA-CT (<36 ng/mL), and all of them showed only focal CCH in the lobe submitted to FNA; three of them were malignant (2 PTC, 1 follicular carcinoma), while two were benign.

Conclusions: Employing the currently proposed cut-off values, false-positive FNA-CT results may be observed in benign/malignant TNs with coexisting diffuse CCH. FNA-CT must therefore be cautiously used in the diagnostic approach for patients with TNs and a slightly increased basal or stimulated serum CT concentration in order to avoid unnecessary surgery.

Keywords: CCH; FNA-CT; MTC; calcitonin; thyroidectomy.

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Conflict of interest statement

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

Figures

Figure 1
Figure 1
Diffuse C-cell hyperplasia (cells stained brown at immunohistochemistry) of the thyroid lobe was submitted to FNA.
Figure 2
Figure 2
Focal C-cell hyperplasia (cells stained brown at immunohistochemistry) in the thyroid lobe was submitted to FNA.
Figure 3
Figure 3
Correlation between basal CT and TN size in the study group with CCH. CT, calcitonin; TN, thyroid nodules.
Figure 4
Figure 4
Correlation between basal CT and TN size in the control group with MTC. CT, calcitonin; TN, thyroid nodules; R² = 0.8726.
See this image and copyright information in PMC

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