Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2022 Apr;46(4):820-828.
doi: 10.1007/s00268-022-06448-6. Epub 2022 Jan 28.

Extension of Prophylactic Surgery in Medullary Thyroid Carcinoma. Differences Between Sporadic and Hereditary Tumours According to Calcitonin Levels and Lymph Node Involvement

L D Juez  1 , E Mercader  2 , I Amunategui  2 , B Febrero  3 , J M Rodríguez  3 , J Gómez-Ramírez  4 ; MECANO Collaboration Group
Collaborators, Affiliations
Observational Study

Extension of Prophylactic Surgery in Medullary Thyroid Carcinoma. Differences Between Sporadic and Hereditary Tumours According to Calcitonin Levels and Lymph Node Involvement

L D Juez et al. World J Surg. 2022 Apr.

Abstract

Introduction: Currently, there is no consensus on the indication of prophylactic surgery of the nodal compartments in the treatment of medullary thyroid carcinoma (MTC). The aim of our study was to perform a correlation study between preoperative calcitonin (basalCT) values and lymph node involvement to establish a criterion on which to base prophylactic surgery in these patients.

Material and methods: We conducted an observational, retrospective and multicentre study with 29 hospitals. Patients over 18 years of age with a diagnosis of MTC with a pre-surgical calcitonin registry were included. The minimum surgery in all patients had to have been total thyroidectomy (TT) with central compartment lymph node dissection (CCLND). Receiver operating characteristic (ROC) curve analysis was used to establish basalCT cut-off values as predictors of postoperative lymph node involvement.

Results: A total of 244 patients were included. Baseline calcitonin (basalCT) was a good predictor of nodal involvement (AUC 0.718 and 95%CI 0.66-0.978). Heritability was identified as a preoperative factor correlated with baseline tumour CT values (p = 0.000). With a probability of lymph node involvement below 10%, new cut-off points were established. A prophylactic bilateral lateral lymph node dissection in sporadic tumours should be performed at a basalCT > 600 pg/mL; in the case of RET-mutated tumours this value would be 200 pg/mL.

Conclusion: The baseline CT value is a good predictor of postoperative lymph node involvement in MTC, however, cut-off points should depent on the hereditary nature of the tumour.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flow diagram for study participants
Fig. 2
Fig. 2
ROC curve of the basalCT, basalCEA and tumour size and lymph node involvement
Fig. 3
Fig. 3
Relationship between BasalCT and lymph node involvement by lymph node regions, as well as pre-surgical ultrasound
Fig. 4
Fig. 4
A new proposal algorithm for managing MTC based on its sporadic or hereditary nature according to basalCT levels
See this image and copyright information in PMC

References

    1. Melvin KE, Tashjian AH. The syndrome of excessive thyrocalcitonin produced by medullary carcinoma of the thyroid. Proc Natl Acad Sci U S A. 1968;59(4):1216–1222. doi: 10.1073/pnas.59.4.1216. - DOI - PMC - PubMed
    1. Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, et al. Revised American thyroid association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015;25(6):567–610. doi: 10.1089/thy.2014.0335. - DOI - PMC - PubMed
    1. Moley JF. Medullary thyroid carcinoma: management of lymph node metastases. JNCCN J Natl Compr Cancer Netw. 2010;8(5):549–556. doi: 10.6004/jnccn.2010.0042. - DOI - PubMed
    1. Joaquin GR (2020) Cirugía endocrina. Cirugía Endocrina
    1. Viola D, Elisei R. Management of medullary thyroid cancer. Endocrinol Metab Clin North Am. 2019;48(1):285–301. doi: 10.1016/j.ecl.2018.11.006. - DOI - PubMed

Publication types

Substances

Supplementary concepts