Medullary thyroid carcinoma (MTC) presentation is classified in a high-risk/suspicion category of risk stratification in only around half of the cases, according to the results of a new study published in Clinical Endocrinology.

“This advises for further studies, ideally supported by international societies, to better define the [ultrasound] presentation of MTC,” the researchers wrote.

Ultrasound is the pivotal procedure when diagnosing thyroid nodules. Researchers have recently developed many ultrasound-based risk stratification systems. However, the performance of these systems in detecting MTC has not been investigated thoroughly.

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Here, a team of researchers led by Pierpaolo Trimboli, MD, conducted a systemic review and meta-analysis with the aim to clarify how MTC is classified according to risk stratification systems, whether risk stratification systems are able to correctly classify MTC at high risk/suspicion, and whether the disease is classified as suspicious at the ultrasound when risk stratification systems are not used.

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A total of 25 articles were included in the analysis. According to the American Thyroid Association system, 65% of MTCs were assessed at high and 25% were assessed at intermediate suspicion. Only a little over half (54.8%) of MTCs were in a high-risk/suspicion category, considering all risk stratification systems.

When the researchers pooled data from research articles that did not have data on risk stratification systems, the prevalence of MTC suspicion was 60%.

“MTC presentation according to [risk stratification systems] is partially known,” the researchers concluded. They suggested that more research is needed to better define the ultrasonographic presentation of MTC and to improve the accuracy of risk stratification systems.


Ferrarazzo G, Camponovo C, Deandrea M, Piccardo A, Scappaticcio L, Trimboli P. Suboptimal accuracy of ultrasound and ultrasound-based risk stratification systems in detecting medullary thyroid carcinoma should be not overlooked. Findings from a systematic review with meta-analysis. Clin Endocrinol. Published online April 13. 2022. doi:10.1111/cen.14739