Calcitonin measurement in fine-needle aspirate washout fluid by electrochemiluminescence immunoassay for thyroid tumors

Minoru Kihara, Mitsuyoshi Hirokawa, Takumi Kudo, Toshitetsu Hayashi, Masatoshi Yamamoto, Hiroo Masuoka, Takuya Higashiyama, Mitsuhiro Fukushima, Yasuhiro Ito, Akihiro Miya, Akira Miyauchi, Minoru Kihara, Mitsuyoshi Hirokawa, Takumi Kudo, Toshitetsu Hayashi, Masatoshi Yamamoto, Hiroo Masuoka, Takuya Higashiyama, Mitsuhiro Fukushima, Yasuhiro Ito, Akihiro Miya, Akira Miyauchi

Abstract

Purpose: For the differential diagnosis of medullary thyroid carcinoma (MTC) on thyroid nodules, ultrasound-guided fine-needle aspiration cytology is a useful and safe procedure, but its diagnostic accuracy is not high enough. As an ancillary method to accurately diagnose MTC, the calcitonin in fine-needle aspirate washout fluid (FNA-Ct) is used. However, no data are available about cut-off values of FNA-Ct using the currently available electrochemiluminescence immunoassay (ECLIA).

Methods: We investigated 180 thyroid nodules in 141 patients. After smearing, the syringe and needle used for the FNA were rinsed with normal saline (0.5 mL). The calcitonin in the washout was measured by ECLIA.

Results: The FNA-Ct in the non-MTC nodules of MTC patients, non-MTC nodules of non-MTC patients, and MTC nodules were 10.6-2100 pg/mL (median 24.6 pg/mL), < 0.5-21.0 pg/mL (median < 0.5 pg/mL), and 94.9-4,070,000 pg/mL (median 177,000 pg/mL), respectively. A receiver operating characteristic analysis of the MTC nodules and the non-MTC nodules of the non-MTC patients indicated that the cut-off value was 21.0 pg/mL, leading to 100% sensitivity and 100% specificity.

Conclusions: This is the first study to determine the cut-off value of FNA-Ct with an ECLIA, and we propose that the optimal cut-off value is 21.0 pg/mL.

Keywords: Calcitonin; ECLIA; Electrochemiluminescence immunoassay; Fine-needle aspiration washout fluid; Medullary thyroid carcinoma.

Conflict of interest statement

This study was approved by the Ethics Committee in Kuma Hospital. Written informed consent for their case to be used was obtained from each patient.All authors provide consent for this publication.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Calcitonin values in fine-needle aspirate washout fluid using ECLIA in non-MTC nodules
Fig. 2
Fig. 2
Calcitonin values in fine-needle aspirate washout fluid using ECLIA in the MTC nodules and in the non-MTC nodules of non-MTC patients
Fig. 3
Fig. 3
ROC curve of Calcitonin values in fine-needle aspirate washout fluid using ECLIA in the MTC nodules and in the non-MTC nodules of non-MTC patients
Fig. 4
Fig. 4
The FNA-Ct / serum calcitonin ratios in the MTC nodules and the non-MTC nodules of the MTC patients
Fig. 5
Fig. 5
ROC analysis for the MTC nodules and the non-MTC nodules of the MTC patients

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