Surgical Approach to the Management of Medullary Thyroid Cancer: When Is Lymph Node Dissection Needed?

Paraskeva, Panoraia; Katsaronis, Paraskevas; Tasiopoulou, Georgia; Kontzoglou, Konstantinos

doi:10.1159/000351148

Cited by 20 publications

(15 citation statements)

References 64 publications

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“…Because MTC has been reported with a high rate (50–75%) of lymph node metastases and substantial incidence of multifocal tumors (0–22%), postoperative evaluation and treatment turns out to be critical for the outcome [17–19]. Neck ultrasound and other imaging studies (neck or chest CT scan, bone scan) are considered to evaluate the residual or metastatic tumor burden if the detectable calcitonin is still >150 pg/mL.…”

Section: Discussionmentioning

confidence: 99%

A cohort study on 10‐year survival of sporadic medullary thyroid carcinoma with somatic RET mutation

Chuang

Hwang

Tsai

et al. 2016

The Kaohsiung J of Med Scie

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Somatic rearranged during transfection (RET) mutations are reported in 40-50% of sporadic medullary thyroid carcinoma (sMTC) patients with prognostic significance. As there is a lack of somatic RET mutations reported previously for the Taiwanese population, we tried to assess the presence of somatic RET mutations and evaluate the potential outcome predictors for our sMTC patients. We collected data from seven sMTC patients from the years 1997 to 2005 and analyzed their clinic-pathological features up to 2015. All patients were still alive to follow up for 11∼18 years. Tumor DNAs were extracted to assess exons 10-11 and 13-16, and the intron-exon boundaries of the RET gene. Six cases (86%) were screened positive of somatic RET gene mutations in hotspot regions, one at M918T, one at C620R, and three at C634S, with another two rare mutations at L629Q and V642I. Comparing the current tumor, node, metastases staging system, the 10-year survival outcomes for our sMTC patients was not predicted by serum calcitonin and/or carcinoembryonic antigen, surgical extent, and presence of the somatic RET gene mutations. The small cohort demonstrated a relatively good outcome of sMTC patients to survive >10 years. In addition, intensive treatment with total thyroidectomy with extensive neck lymph node dissection seemed to be the critical determinant of better survival outcome for sMTC patients.

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Section: Discussionmentioning

confidence: 99%

A cohort study on 10‐year survival of sporadic medullary thyroid carcinoma with somatic RET mutation

Chuang

Hwang

Tsai

et al. 2016

The Kaohsiung J of Med Scie

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“…Some authors advocate that lateral lymph node dissection should only be reserved for cases of positive for lateral lymph node metastatic disease imaging or histological findings. Others propose the evaluation of preoperative Ct levels and tumor size as criteria for deciding whether it is necessary or not [ 37 , 38 ]. In cases of a tumor over 3 mm and Ct levels ranging between 20 pg/mL and 200 pg/mL, ipsilateral lateral lymph node dissection is advised as it increases the percentage of biochemical cure.…”

Section: ⧉ Surgical Treatmentmentioning

confidence: 99%

Medullary thyroid cancer: molecular factors, management and treatment

Pavlidis

Sapalidis²,

Chatzinikolaou³

et al. 2021

Rom J Morphol Embryol

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Medullary thyroid cancer (MTC) is an infrequent neuroendocrine tumor, which amounts to 3–5% of all thyroid malignancies. Approximately 75–80% of MTCs are sporadic neoplasms. The rest of 20–25% are familial cases that belong to multiple endocrine neoplasia (MEN) syndromes, specifically MEN2 and MEN3. These cases of familial MTC are attributed to an activating germline mutation of a tyrosine kinase receptor gene, the rearranged during transfection ( RET ) proto-oncogene, located on chromosome 10q11.21. These mutations are also found in some cases of sporadic MTC. This review sets forth in summary the accepted guidelines and approaches regarding diagnosis, management, and treatment of MTC. Surgical resection is the standard care, and an early, prophylactic intervention is performed in genetic cases. Further investigation and understanding of the molecular pathways involved in the growth and advancement of MTC is required in order to provide efficient therapy in cases of progressive disease.

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“…Non-microcarcinoma requires total thyroidectomy or near-total thyroidectomy and central neck (level VI) dissection. 1,2 Hypoparathyroidism is one of the most common complications of thyroidectomy, in which the parathyroid is unintentionally devascularized or excised because it is difficult to discriminate and separate the parathyroid gland from the surrounding lymph nodes. 3 The yellow color of the parathyroid glands may be confused with the surrounding fat.…”

Section: Introductionmentioning

confidence: 99%

A Carbon Nanoparticle Lymphatic Tracer Protected Parathyroid Glands During Radical Thyroidectomy for Papillary Thyroid Non-Microcarcinoma

et al. 2016

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The study assessed the role of an activated carbon nanoparticle lymphatic tracer in reducing unintentional damage to the parathyroid glands during thyroidectomy for papillary thyroid non-microcarcinoma diagnosed intraoperatively by cryosections. A total of 103 patients with papillary thyroid non-microcarcinomas diagnosed by intraoperative cryosection were randomly assigned to receive routine radical thyroidectomy or radical thyroidectomy following administration of activated carbon nanoparticle lymphatic tracer to the contralateral thyroid, at the department of Thyroid Surgery, Sun Yat-sen Memorial Hospital (Guangzhou, China), between January 2012 and May 2013. The success of level VI lymphadenectomy and postoperative parathyroid function were compared. Administration of the activated carbon nanoparticle lymphatic tracer did not affect the frequency of recovered lymph nodes containing metastases; however, it did significantly reduce the incidence of permanent and transient hypoparathyroidism from 2 to 0 and 18 to 6, and reduced the mean recovery time for transient hypoparathyroidism from 57.0 days to 22.3 days. Administration of activated carbon nanoparticles to the contralateral thyroid after intraoperative cryosections did not contribute to lymphadenectomy for papillary thyroid non-microcarcinoma, but significantly protected parathyroid functions. This approach could decrease the morbidity of radical thyroidectomy and the occurrence of hypoparathyroidism.

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Surgical Approach to the Management of Medullary Thyroid Cancer: When Is Lymph Node Dissection Needed?

Cited by 20 publications

References 64 publications

A cohort study on 10‐year survival of sporadic medullary thyroid carcinoma with somatic RET mutation

A cohort study on 10‐year survival of sporadic medullary thyroid carcinoma with somatic RET mutation

Medullary thyroid cancer: molecular factors, management and treatment

A Carbon Nanoparticle Lymphatic Tracer Protected Parathyroid Glands During Radical Thyroidectomy for Papillary Thyroid Non-Microcarcinoma

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