Comprehensive evaluation of medullary thyroid carcinoma before surgery

Area of Science:

• Oncology
• Radiology
• Diagnostic Imaging

Background:

• Medullary thyroid carcinoma (MTC) is a rare but aggressive endocrine neoplasm.
• Accurate preoperative diagnosis of MTC is essential for appropriate patient management.

Purpose of the Study:

• To enhance the diagnostic accuracy of medullary thyroid carcinoma (MTC) before surgery.
• To analyze clinical and ultrasonic data to identify factors associated with MTC misdiagnosis.

Main Methods:

• Retrospective review of clinical and sonographic data from 71 patients (96 lesions) with histopathologically confirmed MTC.
• Comparison of characteristics between correctly diagnosed and misdiagnosed MTC groups using statistical tests (t-test, Mann-Whitney U, chi-square, Fisher exact).

Main Results:

• MTC lesions with cystic changes, circumscribed margins, regular shapes, lack of calcification, and rare vascularity were more frequently misdiagnosed.
• Misdiagnosed MTC showed significantly higher proportions of cystic change (25.0% vs 4.2%) and lower proportions of uncircumscribed margins (20.8% vs 74.7%) and calcification (20.8% vs 56.3%) compared to correctly diagnosed lesions.

Conclusions:

• Ultrasound can misdiagnose atypical MTC presentations (e.g., cystic, circumscribed, regular shape, no calcification) as benign.
• A combined approach utilizing ultrasound, cytology, and serum calcitonin levels is recommended for reliable preoperative MTC diagnosis.