How Do You Determine the Potential for Cure for Medullary Thyroid Cancer MCT? A Novel New Test. Calcitonin Secretory Index CSI.
Endocrine Practice 24(5) May 2108 p.460-467
Filimon S. et al
Dr.Guttler comments on this article.
- What is CSI?It takes the serum calcitonin and the size of the cancer nodule to make an index.
- CSI in ng/ml/mm was better at predicting early lymph node spread.
- Calcitonin correlated with tumor size and number of positive nodes.
- Cure of MCT declines when the CSI is > 30 ng/ml/mm of tumor size.
- Recent case had a 44 mm MCT nodule and a serum calcitonin of 5.443 ng/ml. The CSI index to see if she has a chance for a cure.
- CSI < 30 resulted in cures in those patients without lymph node involvement.
- > 30 CSI there was persistent disease in the lateral neck lymph nodes.
- CSI < 30 may be used to tell if someone has a chance to be disease free of MCT after thyroidectomy. High CSI mandates a bilateral lymph node dissection at the first operation.
- With no approved routine screening calcitonin for MCT in thyroid nodules evaluation in the USA as too expensive,the first line of defence of missing MCT is cytology.
- Pathologists must not miss a patient with MCT when the cytology has eccentric nuclei looking like Hurthle cell neoplasm HCC, but lacking the neucleoli like HCC, and having distinctly different nuclei than follicular tumors.
- The diagnosis is obvious on the first biopsy with distinct cell changes not present with regular follicular lesion.
- Missing a MCT can result in years of treatment for the wrong cancer and with it unnecessary radioiodine therapy.
- It is always wise to get another opinion before preceding with surgery.It may be the wrong surgery or you may not need surgery at all.
- Call me at 310-393-8860 or [email protected] for details.
- Richard Guttler MD,FACE,ECNU