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Exp Clin Endocrinol Diabetes 2002; 110(8): 403-407
DOI: 10.1055/s-2002-36546
Article

© Johann Ambrosius Barth

Role of Conventional Ultrasound and Color Doppler Sonography in the Diagnosis of Medullary Thyroid Carcinoma

B. Saller 1 , L. Moeller 1 , R. Görges 2 , O. E. Janssen 1 , K. Mann 1
  • 1 Division of Endocrinology, Department of Internal Medicine, University of Essen, Germany
  • 2 Division of Endocrinology, Clinic of Nuclear Medicine, University of Essen, Germany
Further Information

Publication History

received 10 July 2001 first decision 8 January 2002

accepted 6 June 2002

Publication Date:
08 January 2003 (online)

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Summary

Early diagnosis of medullary thyroid carcinoma (MTC) can improve long-term prognosis. MTC can be detected at an early stage by calcitonin screening in all patients with thyroid nodules. This approach, however, is controversial due to high costs and a limited specificity of calcitonin. It was the aim of the present study to investigate whether ultrasonography may contribute to the diagnosis of MTC in patients with thyroid nodules. The study included 19 patients with newly diagnosed MTC. Ten patients had sporadic MTC, 7 had multiple endocrine neoplasia (MEN) type 2A, and 2 patients had MEN 2B. In all subjects conventional ultrasound, and in 14 patients color Doppler sonography were performed before primary surgery. For comparison, ultrasound appearance of 139 benign thyroid nodules was evaluated. In conventional ultrasound, MTC in 17/19 (89%) patients were hypoechoic, contained intranodular calcifications, and had no “halo sign”. The combination of these criteria were found in only 8/139 (6%) of benign thyroid nodules. Intranodular blood flow was found in 11/14 patients with MTC (79%), perinodular blood flow in 7/14 MTC (50%).

In conclusion, conventional ultrasound reveals a combination of hypoechogenicity, intranodular calcifications, and absence of “halo sign” in the vast majority of MTC. Since this sonographic pattern only rarely occurs in benign thyroid nodules, the results indicate that thyroid ultrasound can contribute to the diagnosis of MTC. In addition, the findings may have implications for calcitonin screening in nodular thyroid disease.

Key words:

Medullary thyroid carcinoma - Thyroid nodule - Ultrasound - Color Doppler sonography - Calcitonin

References

  • 1 Brkljacic B, Cuk V, Tomic B H, Bence Z Z, Delic B D, Drinkovic I. Ultrasonic evaluation of benign and malignant nodules in echographically multinodular thyroids.  J Clin Ultrasound. 1994;  22 71-76
    PubMedGoogle Scholar
  • 2 Clark K J, Cronan J J, Scola F H. Color Doppler sonography: anatomic and physiologic assessment of the thyroid.  J Clin Ultrasound. 1995;  23 215-223
    CrossrefPubMedGoogle Scholar
  • 3 Eng C. The RET proto-oncogene in multiple endocrine neoplasia type 2 and Hirschsprung disease.  N Engl J Med. 1996;  335 943-951
    CrossrefPubMedGoogle Scholar
  • 4 Frank-Raue K, Hoeppner W, Buhr H, Herfarth C, Raue F. Results and follow-up in eleven MEN 2 A gene carriers after prophylactic thyroidectomy.  Exp Clin Endocrinol Diabetes. 1997;  4 76-78
    PubMedGoogle Scholar
  • 5 Freitas J E, Freitas A E. Thyroid and parathyroid imaging.  Semin Nucl Med. 1994;  24 234-245
    PubMedGoogle Scholar
  • 6 Giuffrida D, Gharib H. Current diagnosis and management of medullary thyroid carcinoma.  Ann Oncol. 1998;  9 695-701
    CrossrefPubMedGoogle Scholar
  • 7 Gorman B, Charboneau J W, James E M, Reading C C, Wold L E, Grant C S, Gharib H, Hay I D. Medullary thyroid carcinoma: role of high-resolution US.  Radiology. 1987;  162 147-150
    PubMedGoogle Scholar
  • 8 Hegedüs L, Karstrup S. Ultrasonography in the evaluation of cold thyroid nodules.  Eur J Endocrinol. 1998;  138 30-31
    CrossrefPubMedGoogle Scholar
  • 9 Holden A. The role of colour and duplex Doppler ultrasound in the assessment of thyroid nodules.  Australas Radiol. 1995;  39 343-349
    PubMedGoogle Scholar
  • 10 Horvit P K, Gagel R F. Editorial: The goitrous patient with an elevated serum calcitonin - what to do?.  J Clin Endocrinol Metab. 1997;  82 335-337
    CrossrefPubMedGoogle Scholar
  • 11 Lamb E J, Heddle R M, Ellis A. Spuriously elevated plasma calcitonin in a patient with a thyroid nodule not associated with medullary thyroid carcinoma.  Postgrad Med J. 1999;  75 289-290
    PubMedGoogle Scholar
  • 12 Leclere J, Sidibe S, Lassau N, Gardet P, Caillou B, Schlumberger M, Romaniuk C, Parmentier C. Ultrasonographic aspects of hepatic metastases of thyroid medullary cancers.  J Radiol. 1996;  77 99-103
    PubMedGoogle Scholar
  • 13 McCook T A, Putman C E, Dale J K, Wells S A. Medullary carcinoma of the thyroid: radiographic features of a unique tumor.  AJR. 1982;  139 149-155
    PubMedGoogle Scholar
  • 14 Modigliani E, Cohen R, Campos J M, Conte-Devolx B, Maes B, Boneu A, Schlumberger M, Bigorgne J C, Dumontier P, Leclerc L, Corcuff B, Guilhem I. Prognostic factors for survival and for biochemical cure in medullary thyroid carcinoma: results in 899 patients. The GETC Study Group. Groupe d'etude des tumeurs a calcitonine.  Clin Endocrinol (Oxf). 1998;  48 265-273
    CrossrefPubMedGoogle Scholar
  • 15 Niccoli P, Wion-Barbot N, Caron P, Henry J F, de Micco C, Saint Andre J P, Bigorgne J C, Modigliani E, Conte-Devolx B. Interest of routine measurement of serum calcitonin: study in a large series of thyroidectomized patients. The French Medullary Study Group.  J Clin Endocrinol Metab. 1997;  82 338-341
    CrossrefPubMedGoogle Scholar
  • 16 Ozgen A G, Hamulu F, Bayraktar F, Yilmaz C, Tuzun M, Yetkin E, Tuncyurek M, Kabalak T. Evaluation of routine basal serum calcitonin measurement for early diagnosis of medullary thyroid carcinoma in seven hundred seventy-three patients with nodular goiter.  Thyroid. 1999;  9 579-582
    PubMedGoogle Scholar
  • 17 Pacini F, Fontanelli M, Fugazzola L, Elisei R, Romei C, Di Coscio G, Miccoli P, Pinchera A. Routine measurement of serum calcitonin in nodular thyroid diseases allows the preoperative diagnosis of unsuspected sporadic medullary thyroid carcinoma.  J Clin Endocrinol Metab. 1994;  78 826-829
    CrossrefPubMedGoogle Scholar
  • 18 Rago T, Vitti P, Chiovato L, Mazzeo S, De Liperi A, Miccoli P, Viacava P, Bogazzi F, Martino E, Pinchera A. Role of conventional ultrasonography and color flow-Doppler sonography in predicting malignancy in “cold” thyroid nodules.  Eur J Endocrinol. 1998;  138 41-46
    CrossrefPubMedGoogle Scholar
  • 19 Rieu M, Lame M C, Richard A, Lissak B, Sambort B, Vuong-Ngoc P, Berrod J L, Fombeur J P. Prevalence of sporadic medullary thyroid carcinoma: the importance of routine measurement of serum calcitonin in the diagnostic evaluation of thyroid nodules.  Clin Endocrinol (Oxf). 1995;  42 453-460
    CrossrefPubMedGoogle Scholar
  • 20 Shimamoto K, Endo T, Ishigaki T, Sakuma S, Makino N. Thyroid nodules: evaluation with color Doppler ultrasonography.  J Ultrasound Med. 1993;  12 673-678
    PubMedGoogle Scholar
  • 21 Spiezia S, Cerbone G, Colao A, Assanti A P, Picone G M, Lombardi G. Usefulness of power Doppler in the diagnostic management of hypoechoic thyroid nodules.  Eur J Ultrasound. 1997;  6 165-170
    CrossrefPubMedGoogle Scholar
  • 22 Takashima S, Fukuda H, Nomura N, Kishimoto H, Kim T, Kobayashi T. Thyroid nodules: re-evaluation with ultrasound.  J Clin Ultrasound. 1995;  23 179-184
    CrossrefPubMedGoogle Scholar
  • 23 Vierhapper H, Raber W, Bieglmayer C, Kaserer K, Weinhausl A, Niederle B. Routine measurement of plasma calcitonin in nodular thyroid diseases.  J Clin Endocrinol Metab. 1997;  82 1589-1593
    CrossrefPubMedGoogle Scholar
  • 24 Wallace S, Hill C S, Paulus D D, Ibanez M L, Clark R L. Radiologic aspects of medullary (solid) thyroid carcinoma.  Radiol Clin North Am. 1970;  3 463-474
    PubMedGoogle Scholar

Dr. med. Bernhard Saller

Pharmacia GmbH

Endocrinology & Metabolism

Am Wolfsmantel 46

91058 Erlangen

Germany

Phone: + 49/9131/62-1502

Fax: + 49/9131/62-1480

Email: bernhard.saller@pharmacia.com

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