Medullary thyroid cancer - An update

Fugazzola, Laura

doi:10.1016/j.beem.2022.101655

Cited by 13 publications

(18 citation statements)

References 51 publications

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“…It is worth to mention that during post-surgery follow-up, measurement of CEA is not necessary in cases of undetectable levels of serum Ctn. On the contrary, serum CEA levels doubling time, similarly to those obtained for Ctn, is a useful predictors of survival and disease progression ( 31 ).…”

Section: Postoperative Follow-upmentioning

confidence: 99%

Unilateral Surgery for Medullary Thyroid Carcinoma: Seeking for Clinical Practice Guidelines

et al. 2022

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Optimized preoperative diagnostic tools with calcitonin tests, ultrasound features, functional imaging modalities, and genetic testing to detect hereditary forms have led to an increased rate of earlier diagnosis and surgery for medullary thyroid cancer (MTC). This helps to adapt the primary surgery to the tumor stage and avoid surgical overtreatment for localized tumor growth, i.e., deviating from the regularly recommended thyroidectomy with bilateral central lymph node dissection in favor of a limited unilateral approach. To limit primary surgical therapy, it is crucial that the MTC is clinically unifocal, sporadic, and confined to the thyroid, and that calcitonin levels indicate biochemical recovery after surgery. The main requirement for such a limited approach is the availability of frozen section studies that reliably indicate (i) R0 resection of the MTC, (ii) absence of infiltration of the organ capsule, (iii) lack of desmoplasia (i.e., evidence of the metastatic potential of the MTC), (iiii) absence of contralateral disease or precancerous lesions. Informed consent is mandatory from the patient, who has been fully informed of the advantages, disadvantages, and potential risks of not undergoing the “classic” surgical procedure. The aim of this article is to review the guidelines for the management of early-stage MTC.

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Section: Postoperative Follow-upmentioning

confidence: 99%

Unilateral Surgery for Medullary Thyroid Carcinoma: Seeking for Clinical Practice Guidelines

et al. 2022

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“…All patients were followed up at the Department of Thyroid Surgery, China-Japan Union Hospital, Jilin University. Follow-up included measurements of Ctn, thyroglobulin, TSH and free thyroxine in all patients ( 1 ) on suppressive therapy and annual ultrasound examination of the neck ( 7 ). Diagnostic whole-body scans and determination of thyroglobulin after discontinuation of thyroxine were performed 9-12 months after treatment with I131 and thereafter as needed (in patients treated with I131).…”

Section: Methodsmentioning

confidence: 99%

“…Papillary thyroid carcinoma (PTC) accounts for more than 90% of all thyroid carcinomas ( 1 ). PTC arises from follicular epithelial cells derived from the endoderm and grows slowly.…”

Section: Introductionmentioning

confidence: 99%

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Measuring discrepancies between simple medullary and synchronous medullary/papillary thyroid carcinomas: a comparative cross-sectional study

Zhang,

Yang,

Frattini

et al. 2024

Front. Endocrinol.

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ObjectiveTo study the clinicopathological characteristics of patients with synchronous medullary and papillary thyroid carcinomas.MethodsThe clinical data of patients with medullary thyroid carcinoma (MTC) operated in our hospital (Department of Thyroid Surgery, China-Japan Union Hospital, Jilin University) from February 2009 to February 2023 were evaluated using an analytical review approach. They were divided into an observation group (patients with synchronous MTC and papillary thyroid carcinoma PTC) and a control group (simple MTC) according to whether the clinical data were associated with MTC, in order to compare the clinical features, pathological types, stage characteristics and molecular biology characteristics of the two groups and to investigate the follow-up of the two groups.ResultsThe study included 122 MTC, 30 with synchronous MTC/PTC and 92 simple MTC. When the data were compared, the sex ratio, preoperative calcitonin level, preoperative CEA level, presence of calcifications in the MTC lesions, surgical methods, number of MTC lesions, presence of nodular goitre and presence of thyroiditis were higher in the observation group than in the control group. There was a significant difference between the groups when the MTC lesion diameter was ≤1cm in terms of preoperative CEA value (P<0.05); when the MTC lesion diameter was >1cm, there was a statistical difference between the two groups in terms of preoperative Ctn value (P<0.05). Type III was significantly different from the simple group, while type IV was more similar to the simple group. The preoperative serum Ctn value was positively correlated with maximum tumour diameter in both groups, although the correlation was stronger in the easy group. Preoperative CEA was positively correlated with maximum tumour diameter in both groups, with a stronger correlation in the combination group. Preoperative Ctn and CEA were positively correlated with lymph node metastasis in the simple group, whereas there was no apparent correlation with lymph node metastasis in the combination group. The cut-off value of preoperative serum Ctn for cervical lymph node metastases in the simple group was 39.2pg/ml and for lateral cervical lymph node metastases 195.5pg/ml. The cut-off value of preoperative serum Ctn for cervical lymph node metastases in the combination group was 60.79pg/ml and for lateral cervical lymph node metastases 152.6pg/ml. In the simple group, prognosis was significantly worse in the progression group (P<0.001), with no statistical difference between the remission and stable groups. In the combination group, the prognosis of the progression and stable groups was significantly worse than that of the remission group (P<0.001), with no statistical difference between the progression and stable groups.ConclusionIn patients with synchronous medullary and papillary thyroid carcinomas, preoperative Ctn and CEA levels, calcifications, solitary lesions, combined goitre or thyroiditis differ significantly from simple MTC. Therefore, clinical management should pay attention to the above factors and early risk screening should be performed to improve prognosis as much as possible.

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“…MTC is classified as a neuroendocrine tumor originating from neoplastic parafollicular C cells with the unique feature of producing calcitonin (Ctn). MTC represents approximately 5% of all thyroid cancers [2]. Approximately 25% of MTCs are caused by mutation of the RET proto-oncogene and are considered "familial."…”

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confidence: 99%

Preoperative neck ultrasound combined with pathological data can significantly impact the outcome of medullary thyroid carcinoma

Deandrea,

Piticchio,

Mormile

et al. 2023

Endocr J

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The diagnosis of medullary thyroid carcinoma (MTC) is challenging since the accuracy of ultrasound (US) and fine-needle aspiration cytology are suboptimal. As a result, MTC has a generally poor prognosis. The aim of this study was to analyze whether perioperative data can modify the risk of relapse in these patients. The institutional database of Turin Mauriziano Hospital was searched to extract records of MTCs diagnosed between 2000 and 2021. Kaplan-Meier curves and Cox and logistic regression analyses were performed, and the hazard ratio (HR) was calculated. Seventy-three MTC patients (median age 58 yr) were found. Disease-free survival was significantly different according to staging (HR: 9.12; p = 0.037), capsular status (HR: 5.49; p = 0.02), and neck US (HR: 9.19; p = 0.04). In the logistic regression analysis, CEA level (β: -0.01; p = 0.043), histological multifocality (OR: 7.4; p = 0.034), and metastatic lymph nodes at histology (β: -0.13; p = 0.006) were significantly associated with structural recurrence. Two logistic multivariate models best explained the variance in recurrence: 1) neck US presentation plus histological multifocality (AIC: 27; r 2 : 0.37; x 2 : 12.4; p = 0.002) and 2) number of neck metastases plus capsular invasion (AIC: 26; r 2 : 0.40; x 2 : 13.7; p = 0.001). Pathological data are associated with MTC prognosis. Preoperative neck US can significantly help to predict MTC outcome.

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Medullary thyroid cancer - An update

Cited by 13 publications

References 51 publications

Unilateral Surgery for Medullary Thyroid Carcinoma: Seeking for Clinical Practice Guidelines

Unilateral Surgery for Medullary Thyroid Carcinoma: Seeking for Clinical Practice Guidelines

Measuring discrepancies between simple medullary and synchronous medullary/papillary thyroid carcinomas: a comparative cross-sectional study

Preoperative neck ultrasound combined with pathological data can significantly impact the outcome of medullary thyroid carcinoma

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