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International Journal of Endocrinology
Volume 2013 (2013), Article ID 571606, 7 pages
http://dx.doi.org/10.1155/2013/571606
Clinical Study

Twenty Years of Experience with the Preoperative Diagnosis of Medullary Cancer in a Moderately Iodine-Deficient Region

1Thyroid Outpatient Department, Bugat Hospital, 6 Fenyves Street, Matrafured, Gyongyos 3232, Hungary
2Department of Pathology, Bugat Hospital, Dozsa Gyorgy Street, Gyongyos 3200, Hungary
3Department of Nuclear Medicine, Honved Hospital, 44 Robert Karoly Avenue, Budapest 1134, Hungary
4Department of Surgery, Telki Hospital, Telki 2089, Hungary

Received 9 December 2012; Revised 20 January 2013; Accepted 30 January 2013

Academic Editor: A. L. Barkan

Copyright © 2013 Tamas Solymosi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. There is a current debate in the medical literature about plasma calcitonin screening in patients with nodular goiter (NG). We decided on analyzing our 20-year experience with patients in an iodine-deficient region (ID). Patients and Methods. 22,857 consecutive patients with NG underwent ultrasonography and aspiration cytology (FNAC). If FNAC raised suspicion of medullary cancer (MTC), the serum calcitonin was measured. Results. 4,601 patients underwent surgery; there were 23 patients among them who had MTC (0.1% prevalence). Significantly more MTC cases were diagnosed cytologically in the second decade than in the first: 11/12 and 6/11, respectively. The frozen section was of help in 2 cases out of 3. Two patients suffered from a 3-year delay in proper therapy, and reoperation was necessary in 1 case. FNAC raised the suspicion of MTC in 20 cases that were later histologically verified and did not present MTC. The diagnostic accuracy of FNAC in diagnosing MTC was 99.2%. Two false-positive serum calcitonin tests (one of them in a hemodialyzed patient) and one false-negative serum calcitonin test occurred in 40 cases. Conclusion. Regarding the low prevalence of MTC in ID regions, calcitonin screening of all NG patients does not only appear superfluously but may have more disadvantages than advantages.