Thyroid Outpatient Department, Bugat Hospital, 6 Fenyves Street, Matrafured, Gyongyos 3232, Hungary.
Int J Endocrinol. 2013;2013:571606. doi: 10.1155/2013/571606. Epub 2013 Mar 6.
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.
在结节性甲状腺肿（NG）患者的血浆降钙素筛查方面，医学文献中目前存在争议。我们决定分析在碘缺乏地区（ID）的 20 年患者经验。
22857 例连续 NG 患者接受了超声和细针抽吸细胞学检查（FNAC）。如果 FNAC 怀疑为髓样癌（MTC），则测量血清降钙素。
4601 例患者接受了手术；其中有 23 例患有 MTC（患病率为 0.1%）。在第二个十年中，MTC 病例的细胞学诊断明显多于第一个十年：分别为 11/12 和 6/11。有 2 例中的冰冻切片有所帮助。有 2 例患者出现 3 年的治疗延误，其中 1 例需要再次手术。FNAC 对 20 例后来被组织学证实为非 MTC 的病例提出了 MTC 怀疑。FNAC 诊断 MTC 的准确性为 99.2%。在 40 例中，发生了 2 例假阳性血清降钙素检测（其中 1 例为血液透析患者）和 1 例假阴性血清降钙素检测。
鉴于 ID 地区 MTC 的低患病率，对所有 NG 患者进行降钙素筛查不仅显得多余，而且可能弊大于利。
