German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors

Dralle, Henning; Musholt, Thomas J.; Schabram, J.; Steinmüller, Thomas; Frilling, A.; Simon, Dietmar; Goretzki, P. E.; Niederle, Bruno; Scheuba, Christian; Clerici, Thomas; Hermann, Michael; Kußmann, J; Lorenz, Kerstin; Nies, C.; Schabram, P; Trupka, A.; Zielke, A.; Karges, Wölfram; Luster, Markus; Schmid, Kurt Werner; Vordermark, Dirk; Schmoll, H.-J.; Mühlenberg, R; Schober, Otmar; Rimmele, Harald; Machens, Andreas; Surgery, Visceral; Radiooncology,; Hematology, Oncological

doi:10.1007/s00423-013-1057-6

Cited by 241 publications

(205 citation statements)

References 309 publications

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“…Second-tier assessments -Calcitonin Routine measurement of calcitonin in patients with thyroid nodules has the advantage of facilitating the early diagnosis of medullary thyroid carcinoma and, consequently, of being associated with improved 10-year survival of patients with this malignancy [3]. Also in view of these results, some European consensus conferences recommend routine use of calcitonin as screening for medullary thyroid carcinoma [4,5]. The routine measurement of calcitonin in patients with nodular thyroid disease remains controversial in the USA, considering the false-positive results and the resulting low positive predictive value [1].…”

Section: Laboratory Studiesmentioning

confidence: 99%

“…The routine measurement of calcitonin in patients with nodular thyroid disease remains controversial in the USA, considering the false-positive results and the resulting low positive predictive value [1]. However, in view of the fact that an early diagnosis of medullary thyroid carcinoma could improve survival and that fine-needle aspiration cytology does not reliably exclude a diagnosis of medullary thyroid carcinoma [3][4][5], it is advisable to routinely determine calcitonin levels prior to thyroidectomy. In the presence of altered baseline calcitonin levels, it is appropriate to perform a calcium gluconate stimulation test to differentiate between C-cell hyperplasia and medullary thyroid cancer [4].…”

Section: Laboratory Studiesmentioning

confidence: 99%

“…However, in view of the fact that an early diagnosis of medullary thyroid carcinoma could improve survival and that fine-needle aspiration cytology does not reliably exclude a diagnosis of medullary thyroid carcinoma [3][4][5], it is advisable to routinely determine calcitonin levels prior to thyroidectomy. In the presence of altered baseline calcitonin levels, it is appropriate to perform a calcium gluconate stimulation test to differentiate between C-cell hyperplasia and medullary thyroid cancer [4]. Stimulated calcitonin levels ≤100 pg/ ml do not exclude a diagnosis of medullary thyroid carcinoma, whereas the likelihood of a medullary thyroid carcinoma is high for stimulated calcitonin levels >100 pg/ml.…”

Section: Laboratory Studiesmentioning

confidence: 99%

“…Stimulated calcitonin levels ≤100 pg/ ml do not exclude a diagnosis of medullary thyroid carcinoma, whereas the likelihood of a medullary thyroid carcinoma is high for stimulated calcitonin levels >100 pg/ml. A diagnosis of thyroid medullary carcinoma is almost certain for stimulated calcitonin levels >500 pg/ml [4]. -Serum calcium Preoperative measurement of serum calcium is useful for the screening of primary hyperparathyroidism [6].…”

Section: Laboratory Studiesmentioning

confidence: 99%

“…It must be performed in all patients with a clinical suspicion of thyroid nodule and/or nodular goiter and in all cases of incidental radiological finding of thyroid nodular disease (CT or MRI of the neck, thyroidal uptake on 18FDG-PET scan, etc.) [1,4,5]. Ultrasonography allows an accurate morphological evaluation of the thyroid and adjacent regional lymph nodes, and the acquisition of pertinent information:…”

Section: Instrumental Studiesmentioning

confidence: 99%

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Diagnostic, therapeutic and health-care management protocol in thyroid surgery: a position statement of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB)

Rosato

Crea

Bellantone

et al. 2016

J Endocrinol Invest

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members, via e-mail, in the elaboration phase; all the participants of the XI National Congress of the U.E.C. CLUB held in Naples in the final phase. The following were examined: diagnostic pathway and clinical evaluation; mode of admission and waiting time; therapeutic pathway (patient preparation for surgery, surgical treatment, postoperative management, management of major complications); hospital discharge and patient information; outpatient care and follow-up. Results A clear and concise style was adopted to illustrate the reasons and scientific rationales behind behaviors and to provide health-care professionals with a guide as complete AbstractPurpose The diagnostic, therapeutic and health-care management protocol (Protocollo Gestionale DiagnosticoTerapeutico-Assistenziale, PDTA) by the Association of the Italian Endocrine Surgery Units (U.E.C. CLUB) aims to help treat the patient in a topical, rational way that can be shared by health-care professionals. Methods This fourth consensus conference involved: a selected group of experts in the preliminary phase; all Electronic supplementary material The online version of this article

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Section: Laboratory Studiesmentioning

confidence: 99%

Section: Laboratory Studiesmentioning

confidence: 99%

Section: Laboratory Studiesmentioning

confidence: 99%

Section: Laboratory Studiesmentioning

confidence: 99%

Section: Instrumental Studiesmentioning

confidence: 99%

See 3 more Smart Citations

Diagnostic, therapeutic and health-care management protocol in thyroid surgery: a position statement of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB)

Rosato

Crea

Bellantone

et al. 2016

J Endocrinol Invest

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Time to calcitonin normalization after surgery for node-negative and node-positive medullary thyroid cancer

Machens

Lorenz

Dralle

2019

British Journal of Surgery

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Background: It remains unclear when postoperative serum calcitonin levels should be measured in patients with medullary thyroid cancer (MTC) and, specifically, whether this decision should be based on the preoperative calcitonin level or nodal status. Methods:A cohort of patients with previously untreated MTC was studied. Kaplan-Meier analyses, stratified by preoperative calcitonin level, nodal status and number of nodal metastases, were performed to determine time to calcitonin normalization after initial surgery, with statistical analysis by means of the log rank test.Results: Some 213 patients with node-negative and 182 with node-positive MTC were included in the study. Postoperative calcitonin levels normalized in a mean of 3⋅5 versus 3⋅7 days respectively among patients with preoperative calcitonin levels of 10-100 pg/ml (P = 0⋅815); 4⋅8 versus 5⋅3 days in those with preoperative calcitonin levels of 100⋅1-500 pg/ml (P = 0⋅026); 5⋅3 versus 9⋅9 days in patients with preoperative calcitonin levels of 500⋅1-1000 pg/ml (P = 0⋅004); and 6⋅6 versus 57⋅7 days among those with preoperative calcitonin levels exceeding 1000 pg/ml (P < 0⋅001). Calcitonin levels normalized in a mean of 4⋅7 days when nodal metastasis was not present, 5⋅2 days in those with one to five nodal metastases, 7⋅0 days in patients with six to ten nodal metastases, and 57⋅1 days among patients with more than ten nodal metastases. Postoperative calcitonin normalization curves paralleled each other in patients with node-negative MTC, but diverged in those with node-positive disease and with more nodal metastases.Conclusion: Calcitonin levels typically normalize within 1 week; and within a fortnight in those with node-positive MTC and preoperative calcitonin levels of 500⋅1-1000 pg/ml. With node-positive MTC and preoperative calcitonin levels exceeding 1000 pg/ml, and with more than ten nodal metastases, calcitonin normalization takes longer.

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Prediction of biochemical cure in patients with medullary thyroid cancer

Machens

Lorenz

Dralle

2020

British Journal of Surgery

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Background: The impact of number of node metastases versus metastatic lymph node ratio versus AJCC node category on biochemical cure in medullary thyroid cancer (MTC) is not well defined. Methods: Multivariable logistic regression analysis was used to determine clinical and histopathological variables that contribute to biochemical cure in node-positive MTC.Results: Some 584 of 1026 patients with MTC underwent systematic lymph node dissections for node-positive disease; 27⋅4 per cent (54 of 197) were biochemically cured after the initial operation and 13⋅5 per cent (42 of 310 patients) after repeat surgery. Cured patients had significantly less extrathyroid extension (11-14 versus 33⋅2-55⋅6 per cent), fewer lymph node metastases (median 2-4 versus 12-16), a lower metastatic lymph node ratio (median 0⋅05-0⋅08 versus 0⋅23-0⋅28), and were less likely to have AJCC pN1b disease (56-76 versus 89⋅9-91⋅6 per cent) and distant metastases (0 versus 28⋅4-37⋅1 per cent) than patients who were not cured. Biochemical cure curves advanced steadily up to 7-12 node metastases and a metastatic lymph node ratio of 0⋅33, eventually levelling off after 16-17 node metastases and metastatic lymph node ratios of 0⋅45-0⋅65. In logistic regression analysis, number of lymph node metastases (odds ratio (OR) 17⋅24 for more than 20 metastases, OR 5⋅28 for 11-20 metastases, OR 2⋅22 for 6-10 metastases), preoperative basal serum calcitonin (OR 6⋅24 for over 1000 pg/ml), reoperation (OR 5⋅34) and extrathyroid extension (OR 2⋅42) independently predicted failure to reach biochemical cure.Conclusion: Number of lymph node metastases, unlike metastatic lymph node ratio or AJCC node category, determines likelihood of biochemical cure after initial and repeat surgery for node-positive MTC.

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German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors

Abstract: These evidence-based recommendations for surgical therapy reflect various "treatment corridors" that are best discussed within multidisciplinary teams and the patient considering tumor type, stage, progression, and inherent surgical risk.

Cited by 241 publications

References 309 publications

Diagnostic, therapeutic and health-care management protocol in thyroid surgery: a position statement of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB)

Diagnostic, therapeutic and health-care management protocol in thyroid surgery: a position statement of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB)

Time to calcitonin normalization after surgery for node-negative and node-positive medullary thyroid cancer

Prediction of biochemical cure in patients with medullary thyroid cancer

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