Calcitonin measurement in aspiration needle washout fluids has higher sensitivity than cytology in detecting medullary thyroid cancer: a retrospective multicentre study.

OBJECTIVE: Only few studies analysed the capability of cytology in detecting medullary thyroid cancer (MTC), and they reported a low accuracy of this diagnostic technique. Recently, calcitonin (CT) measurement in aspiration needle washout (FNA-CT) of thyroid and neck lesions has been reported as a sensitive tool for MTC. The aim of this study is to compare the sensitivity of FNA-CT and cytology in detecting MTC and to assess a cut-off value of FNA-CT for clinical practice. PATIENTS: Thirty-eight MTC lesions from 36 patients were retrospectively studied, diagnosed and treated in four different centres. Furthermore, 52 nonmedullary lesions from subjects undergone biopsy following increased serum CT were collected as a control group. RESULTS: Cytology detected MTC in 21/37 lesions with 56·8% sensitivity. The median FNA-CT value was 2000 pg/ml (range 58-10 000 pg/ml) in MTC and 2·7 pg/ml (range <2-13 pg/ml) in controls (P < 0·001). Using a cut-off of 39·6 pg/ml, MTC lesions could be identified with 100% sensitivity and specificity. As the most important finding, 14 histologically proved MTC lesions could be detected by FNA-CT, despite they were cytologically diagnosed as benign or nonconclusive. CONCLUSIONS: This study shows, as the first in a multicentre series, that FNA-CT sensitivity is higher than that of cytology in diagnosing MTC. To avoid false-negative MTC by cytology, CT measurement in aspiration needle washout is to be performed in all patients undergoing biopsy following high serum CT.

Suicide and cancer: where do we go from here?

Although suicide in cancer patients is a burdening public health problem with ethical, medical and psychiatric implications, it still has to be clarified why cancer patients commit suicide and how cancer suicides differ from others. Therefore, a review of the literature on suicide and suicidal ideation in cancer patients was conducted, starting from an overview of these issues in the general population. Evidence suggests that suicidality in the general population can be explained according to a genetic and psychological vulnerability to stress. The psychological and physical stressors found to be associated with suicide in cancer patients corroborate this model. Nevertheless, based on the well-described immunological disturbances due to cancer, we propose that suicide is not just a secondary reaction to cancer but is linked to an intrinsic bio-psychological vulnerability to distress. Upcoming studies should better characterize the neurobiology of suicidality in cancer, opening new avenues for treatment and prevention.