BACKGROUND: Conflicting recommendations exist regarding lymph node (LN) surgery in microMTC (<or=10mm). This study aims to correlate biochemical and pathohistological findings in an attempt to define the characteristics of microMTC, thus allowing recommendations for LN surgery. METHODS: Patients with elevated basal (bCT:>or=10pg/ml) and pentagastrin-stimulated calcitonin levels (sCT:>100pg/ml) were selected for initial surgery. None of the patient was a member of any known MTC family. Biochemical and morphological data of microMTC were compared with 146 patients with C-cell hyperplasia (CCH). RESULTS: MicroMTC (tumor diameter: 4.2+/-2.6mm; unifocal:68; multifocal:29) was documented in 97 of 159 (61%) MTC patients. In 11 (11%) patients, 1-19 LNs were involved. Correlating bCT and sCT levels neither predicted N-stage, nor differentiated between microMTC and CCH. CONCLUSIONS: The biochemical discrimination cannot be made between patients with CCH and MTC, and patients with MTC with/without LN metastasis. Thus, thyroidectomy and central neck dissection is indicated in patients with "mildly" elevated sCT levels (<560pg/ml) (LN positive: 1 of 37 patients [2.7%]). A lateral neck dissection may be added "on demand" (in the setting of measurable postoperative bCT and/or sCT levels indicating LN metastasis). Patients with "highly" elevated sCT (>or=560pg/ml) must be treated as "palpable" MTC (LN positive: 10 of 54 patients [18.5%]).
BACKGROUND: Conflicting recommendations exist regarding lymph node (LN) surgery in microMTC (<or=10mm). This study aims to correlate biochemical and pathohistological findings in an attempt to define the characteristics of microMTC, thus allowing recommendations for LN surgery. METHODS:Patients with elevated basal (bCT:>or=10pg/ml) and pentagastrin-stimulated calcitonin levels (sCT:>100pg/ml) were selected for initial surgery. None of the patient was a member of any known MTC family. Biochemical and morphological data of microMTC were compared with 146 patients with C-cell hyperplasia (CCH). RESULTS: MicroMTC (tumor diameter: 4.2+/-2.6mm; unifocal:68; multifocal:29) was documented in 97 of 159 (61%) MTCpatients. In 11 (11%) patients, 1-19 LNs were involved. Correlating bCT and sCT levels neither predicted N-stage, nor differentiated between microMTC and CCH. CONCLUSIONS: The biochemical discrimination cannot be made between patients with CCH and MTC, and patients with MTC with/without LN metastasis. Thus, thyroidectomy and central neck dissection is indicated in patients with "mildly" elevated sCT levels (<560pg/ml) (LN positive: 1 of 37 patients [2.7%]). A lateral neck dissection may be added "on demand" (in the setting of measurable postoperative bCT and/or sCT levels indicating LN metastasis). Patients with "highly" elevated sCT (>or=560pg/ml) must be treated as "palpable" MTC (LN positive: 10 of 54 patients [18.5%]).
Authors: M Puccini; G Manca; C Ugolini; V Candalise; A Passaretti; J Bernardini; G Boni; P Buccianti Journal: J Endocrinol Invest Date: 2014-06-21 Impact factor: 4.256
Authors: Garth F Essig; Kyle Porter; David Schneider; Debora Arpaia; Susan C Lindsey; Giulia Busonero; Daniel Fineberg; Barbara Fruci; Kristien Boelaert; Johannes W Smit; Johannes Arnoldus Anthonius Meijer; Leonidas H Duntas; Neil Sharma; Giuseppe Costante; Sebastiano Filetti; Rebecca S Sippel; Bernadette Biondi; Duncan J Topliss; Furio Pacini; Rui M B Maciel; Patrick C Walz; Richard T Kloos Journal: Thyroid Date: 2016-10-11 Impact factor: 6.568